胫骨近端瘤段骨切除定制假体置换术后腓总神经损伤的原因探讨

Common peroneal nerve injury after segmental resection and custom-made prosthesis replacement in patients with bone tumor of proximal tibia

目的探讨胫骨近端瘤段骨切除定制假体置换术后出现腓总神经损伤的原因及相应的预防措施。方法1995以来对23例胫骨近端肿瘤行瘤段骨切除、定制人工膝关节置换术。术后有3例患者发生腓总神经不同程度的损伤(其中2例发生于同时切除腓骨近段者),发生率为13%。结果随访9～26个月,平均16个月。经保守治疗,有2例术后6个月腓总神经功能完全恢复,另1例患者肌力恢复正常,小腿外侧及足背皮肤仍有感觉减退。结论胫骨近端肿瘤瘤段骨切除、定制人工膝关节置换术后腓总神经的损伤的发生原因与术中过度牵拉或压迫神经以及不正确使用电刀所致,大多数不完全性损伤可恢复。

Objective The purpose was focused on discussing the causes and preventive of common peroneal nerve injury following tumor resection and custom-made total knee prosthesis replacement in patients with tumor of proximal tibia. Methods 23 cases of bone tumors of proximal tibia were treated with segmental resection and reconstruction with custom-made total knee prosthesis since 1995, Common peroneal nerve was impaired to some degree postoperatively in 3 cases （ 2 combined with resection of the proximal end of fibula simultaneously） and the incidence rate was 13%. Results Follow-up ranged from nine to twenty-six months. The function of the common peroneal nerve recovered completely in two cases after six months, while the sensory deficit that occurred on the lateral side of leg and dorsal side of foot still remained in another patient （the motor loss had recovered）. Conclusions The common peroneal nerve injury associated with segmental resection and custom-made total knee prosthesis replacement in patients with tumor of proximal tibia is most commonly caused by excessive traction or mechanical compression of the nerve or improper use of electric knife, The function of the common peroneal nerve may recover in most patients with incomplete injury.