膝关节周围皮神经与关节置换术后疼痛关系的解剖研究

Relationship between anatomy of cutaneous nerves around the knee and postoperative pain after total knee arthroplasty

目的通过明确膝关节周围皮神经各个分支的相对位置为临床通过去神经化手术治疗关节置换术后疼痛提供解剖学依据。方法对2具成年防腐尸体(4下肢)及2具新鲜成年尸体(2个下肢)进行解剖,明确各个神经支及皮神经走行的毗邻关系。并通过对这些神经进行磁共振扫描,给临床提供直观立体的形态学参考。结果膝关节周围恒定出现三支皮神经,其分别为股内侧皮神经、隐神经髌下支、股中间皮神经。这些神经位置表浅、直径较细,局部视图较难分辨。通过磁共振三维成像,能够进一步明确神经的走行关系,使各个分支与膝关节周围骨性标志和相对位置易于观察。结论通过膝关节周围皮神经的解剖,可明确在实施膝关节置换术后引起疼痛的病变神经,为指导临床实施去神经化手术解除膝关节置换术后的神经源性疼痛提供指导。

Objective To explore the relative location of cutaneous nerve branches around the knee, so as to provide an anatomical basis for denervation surgery in the treatment of postoperative pain after total knee arthroplasty （ TKA ）. Methods The adjacent relationship of articular and cutaneous nerves around the knee was investigated in 4 cadavers, including 2 adult embalmed cadavers （ 4 lower limbs ） and 2 fresh bodies （ 2 lower limbs ）, which were all dissected. The Magnetic Resonance Imaging （ MRI ） was used to scan the nerves, so as to provide a visualized and 3-dimensional （ 3D ） morphological reference for the clinical application. Results There were 3 cutaneous nerves around the knee, including medial femoral cutaneous nerve, patellar branch of saphenous nerve and intermediate femoral cutaneous nerve. These nerves were superifcially located with smaller diameters, and therefore it was dififcult to distinguish the partial view. Based on the 3D MRI scans, the nerves and their locations could be further clariifed, as well as their relationship to the bone landmarks around them. Conclusions The damaged nerves which cause pain after TKA can be clariifed based on the anatomy of cutaneous nerves around the knee. Under the guidance, the neuropathic pain after TKA can be relieved in the denervation surgery.