中国组织工程研究

中国组织工程研究 ›› 2016, Vol. 20 ›› Issue (53): 8043-8050.doi: 10.3969/j.issn.2095-4344.2016.53.019

• 骨与关节综述 bone and joint review • 上一篇    下一篇

初次全膝关节置换后的腓总神经损伤：危险因素及防治策略研究现状

陈有荣1，万伏银1，郭万首2，王卫国2，程立明2，张启栋2，丁 冉2   

  1. 1北京大学中日友好临床医学院，北京市 100029；2中日友好医院骨关节外科，北京市 100029
  • 修回日期:2016-10-17 出版日期:2016-12-23 发布日期:2016-12-23
  • 通讯作者: 郭万首，博士，主任医师，教授，博士生导师，中日友好医院骨关节外科，北京市 100029
  • 作者简介:陈有荣，男，1990年生，湖南省衡东县人，汉族，北京大学中日友好临床医学院在读硕士，主要从事运动医学及关节置换方面的研究。
  • 基金资助:

    国家自然科学基金项目(81273972)

Common peroneal nerve injury after primary total knee arthroplasty: risk factors and strategies of prevention and treatment

Chen You-rong1, Wan Fu-yin1, Guo Wan-shou2, Wang Wei-guo2, Cheng Li-ming2, Zhang Qi-dong2, Ding Ran2   

  1. 1China-Japan Friendship School of Clinical Medicine, Peking University, Beijing 100029, China; 2Department of Orthopedic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
  • Revised:2016-10-17 Online:2016-12-23 Published:2016-12-23
  • Contact: Guo Wan-shou, M.D., Chief physician, Professor, Doctoral supervisor, Department of Orthopedic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
  • About author:Chen You-rong, Studying for master’s degree, China-Japan Friendship School of Clinical Medicine, Peking University, Beijing 100029, China
  • Supported by:

    the National Natural Science Foundation of China, No. 81273972

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摘要：

文章快速阅读：


文题释义：
神经损伤分度：英国医学研究院神经外科学会将神经损伤分为五度：Ⅰ度为完全损伤，指神经功能完全丧失(M0，S0)：Ⅱ度为重度损伤，指部分肌力和感觉降至1级(M1，S1)：Ⅲ度为中度损伤，指神经支配区部分肌力和感觉降至2级(M2，S2)：Ⅳ度为轻度损伤，指神经支配区部分肌力和感觉降至3级(M3，S3)：Ⅴ度为轻微损伤，指神经支配区部分肌力和感觉降至4级(M4，S4)。
“苹果派”技术：在对膝外翻畸形患者行全膝关节置换时，为平衡关节周围软组织，术者在发生病理性挛缩的关节囊、外侧副韧带、髂胫束及弓状韧带上由内向外作多处横向短切口，以达到松解外侧软组织目的的技术方法。
 
摘要
背景：腓总神经损伤是全膝关节置换罕见但严重的并发症之一，其发生率虽然较低，但随着手术量的增加必然越来越常见。
目的：回顾近年来全膝关节置换术后腓总神经损伤的国内外相关文献，了解其研究进展，识别其可能危险因素、预防措施和治疗方案。
方法：应用计算机检索CNKI数据库、维普中文期刊网、PubMed数据库从1980年1月至2016年8月收录的有关全膝关节置换术后腓总神经损伤的研究文献进行分析，以 “全膝关节置换；腓总神经损伤；腓总神经麻痹”或“total knee arthroplasty；common peroneal nerve injury；common peroneal nerve paralysis；common peroneal nerve palsy”为检索词，排除报道时间较早或重复的研究。共52篇文献或专业书籍符合标准，中文6篇，英文45篇，专业书籍1本。
结果与结论：随着全膝关节置换手术量的增加，术后腓神经损伤必然越来越常见，其一旦发生，则后果严重，故预防是关键，目前公认的危险因素包括：术者误入腓神经损伤危险区、膝关节严重外翻和屈曲畸形、术中粗暴、止血带的不恰当使用、术前神经病变、内科疾病、肥胖、麻醉及术后镇痛方式、血肿形成、局部压迫等。同时术后早期识别腓神经损伤，采取非手术或手术治疗方案，可促进损伤神经修复、防止肌肉萎缩。虽然全膝关节置换后腓神经损伤因素众多，但至目前为止尚未发现确切的病因，该问题仍需进一步深入研究。

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 骨科植入物, 人工关节, 膝, 关节置换, 腓总神经, 损伤, 麻痹, 危险区, 危险因素, 防治策略, 国家自然科学基金

Abstract:

BACKGROUND: Common peroneal nerve injury is one of the rare but serious complications after total knee arthroplasty. With the increased amount of operations, peroneal nerve injury would become more and more common, although the incidence rate is relatively low.

OBJECTIVE: To review the literatures published in recent years and related to common peroneal nerve injury after primary total knee arthroplasty, to explore the research progress, risk factors, prophylactic measures and treatment strategies.
METHODS: A computer-based online search was performed in the databases of Chinese National Knowledge Internet, CqVip and PubMed from January 1980 to August 2016 for the literatures related to peroneal nerve injury after primary total knee arthroplasty. The key words were “total knee arthroplasty, common peroneal nerve injury, common peroneal nerve paralysis, common peroneal nerve palsy” in Chinese and English. Repeated and old studies were excluded. Totally 52 literatures or professional books were in accordance with the inclusion criteria. There were 6 Chinese articles, 45 English articles and 1 professional book.
RESULTS AND CONCLUSION: With the increased amount of total knee arthroplasty, peroneal nerve injury would become more and more common. The consequence would be very serious if this complication happened, so the effective prevention was most important. The accepted risk factors link to common peroneal nerve injury after total knee arthroplasty included: surgeons injured dangerous zone of peroneal nerve, severe flexion or valgus deformity of knee, rough operation, inappropriate use of pneumatic tourniquet, preoperative neuropathy, internal problems, obesity, methods of anesthesia and postoperative analgesia, hematoma formation, and local compression. Meanwhile, early recognition of peroneal nerve injury after total knee arthroplasty, and taking operative or non-operative therapies would promote the recovery of injured nerve and prevent further muscular atrophy. There were many risk factors about peroneal nerve injury after total knee arthroplasty. However, so far, the exact etiology and pathogenesis remain unclearly, and further studies are needed to solve the clinical problem.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Arthroplasty, Replacement, Knee, Peroneal Nerve, Tissue Engineering