膝关节置换术后皮肤麻痹的解剖基础及相关临床研究
The anatomical study of infrapatellar branch of the saphenous nerve and design of a modified incision to decrease numbness following total knee arthroplasty
目的 探讨膝关节置换术后隐神经髌下支损伤所致的皮肤麻痹的解剖基础，改良手术切口，减少膝前皮肤麻木并发症。 方法 解剖观察12例成人尸体下肢标本，观测隐神经髌下支形态、神经束的走行及毗邻关系。设计改良膝外侧皮肤切口行膝关节置换手术入路进行临床验证，比较术后效果。 结果 解剖研究发现隐神经髌下支自缝匠肌穿出后，标本在髌骨中心平面神经距髌骨内侧缘约3.2 cm，75%标本有3束分支分布于髌骨下极及胫骨粗隆区域，以髌骨下极与粗隆连线中点为中心作圆，神经纤维主要分布左侧在第2象限，右侧在第1象限。临床研究采用改良膝关节外侧切口行膝关节置换术15例，方法可行，术后膝前皮肤麻木的发生率及范围较对照组减少，有统计学意义。 结论 根据膝关节隐神经髌下支解剖分布特点，改良膝前皮肤切口行膝关节置换术可减少术后膝前麻木。
Objective To explore the infrapatellar branch of the saphenous nerve (IPBSN) that is apt to be injured during total knee arthroplasty (TKA), leading to numbness in its area of distribution, and modify the incision of TKA to decrease numbness. Methods 12 cadaveric knees were dissected, the origin of the nerve was traced in relation with the sartouius muscle and the knee anatomy mark, the course and terminal branches of the nerve were observed and recorded. Then a modified knee lateral incision for TKA was designed, and the results were collected and compared with the med-line incision group. Results The nerve was found to the emerge near the anterior border of sartorius muscle, with a distance to the medial margin of the patella being 3.2 cm. In a majority of the cases (75%), there were 3 branches between the apex of patella and tibial tuberosity; in the center of the patella tendon, a coordinate system was made, and the majority of the nerve fibers lied in the first quartile of the right knee, and in the second quartile of the left knee. 15 TKA cases were performed using the modified lateral incision. The surgery was uneventful, and the post-operation numbness rate and scope were significantly reduced than in the control group. Conclusion By enriching the knowledge of these variable anatomical position of the IPBSN, an modified lateral incision for TKA with reduced incidence of numbness is feasible and valuable.
Infrapatellar branch(IPBSN) / Total knee arthroplasty(TKA) / Numbness / Incision
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