摘要
目的：探讨微创切口与传统切口对全膝关节置换术（ TKA）后切口外侧皮肤感觉障碍面积大小及其转归的影响。方法前瞻性观察2011年7—12月拟行TKA患者术后切口外侧皮肤感觉障碍情况，按入院时间顺序前40膝纳入微创切口组，后80膝纳入传统切口组。微创切口组采用微创髌旁内侧切口，传统切口组采用传统膝前正中切口。记录患者术前相关信息，包括体质量、身高、年龄、性别、手术方式、膝关节美国纽约特种外科医院评分（ HSS评分）及膝关节活动度；术中患者止血带时间、手术切口长度、切口下极距胫骨结节上缘距离、切口上极距髌骨上缘距离。分别于术后6周、6个月、1年和2年对患者进行随访，测量患者切口外侧皮肤感觉障碍面积、HSS评分、膝关节活动度。对切口长度、切口位置与术后切口外侧皮肤感觉障碍面积及其转归进行相关分析。结果微创切口组有38例39膝，传统切口组有73例78膝完成随访，两组患者性别例数、患膝侧别、年龄、身高及体质量差异均无统计学意义（P值均〉0．05）。患者术后均出现了切口外侧皮肤感觉障碍，但微创切口组患者的触觉和痛觉障碍面积在各随访时间点均小于传统切口组，差异均有统计学意义（P值均0．05）。结论 TKA术中对膝前皮神经的切断可造成术后切口外侧皮肤感觉功能障碍，与传统切口相比，微创术后切口外侧皮肤感觉障碍的面积更小，恢复速度更快。
Objective To compare the effect of minimally-invasive incision versus conventional incision on the areas and prognoses of the lateral skin flap numbness after total knee arthroplasty （TKA）. Methods A prospective survey of the patients undergone TKA were conducted between July 2011 and December 2011. One hundred and twenty patients were divided into two groups, group A （ minimally-invasive incision） including the first 40 knees and group B （ conventional incision） including the latter 80 knees by their sequences of admission. Characteristics including weight, height, age, gender, surgery procedure, the Hospital for Special Surgery （ HSS ） score, range of motion of the knee were collected preoperatively, and the tourniquet time, length of incision, distances between inferior incision pole and tibial tubercle, and distances between superior incision pole and superior patella border were recorded postoperatively. Area of lateral skin flap numbness, HSS score and range of motion were recorded at 6 weeks, 6 months, 1 year and 2 years follow-ups. The influence of the incision length, incision location on the area of sensory loss at the lateral skin of the incision and its sequelae were analyzed. Results Thirty-nine knees from 38 patients in minimally-invasive incision group and 78 knees from 73 patients in conventional incision were followed up. There was no significant statistical difference in two groups in terms of case number of female and male, left and right knee, age, height, weight（all P values 〉0. 05）. All patients were found with the lateral flap numbness after surgery. The numbness areas of touch and pain of patients in group A were significantly smaller than those of group B （all P values0. 05）. No correlation between the numbness area and tourniquet inflation time, HSS score or range of motion respectively were found（all P values 〉0. 05）. Conclusions The abscission of cutaneous nerves of anterior knee joint during TKA can cause postoperative numbness of lateral skin flap. Minimally-invasive incision has smaller numbness area and faster recovery than the conventional incision.
出处
《中华解剖与临床杂志》
2015年第1期1-6,共6页
Chinese Journal of Anatomy and Clinics
基金
卫生行业科研专项项目（201302007）
关键词
关节成形术
置换
膝
感觉障碍
皮肤
Arthroplasty,replacement,knee
Sensation disorders
Skin
