全膝关节置换术后切口周围皮缘坏死的原因分析

Risk factors for derma necrosis around incision after total knee arthroplasty

目的探讨人工全膝关节置换术后切口周围皮缘坏死的原因及防治措施。方法2003年1月至2005年11月，全膝关节置换382例患者（494膝）中发生切口周围皮缘坏死15例，回顾性分析这15例患者的临床资料。术前美国特种外科医院膝关节评分（HSS）平均60分。结果伤口清创后所有患者均获愈合，平均愈合时间较正常延长3周以上；9例患者术后伸膝乏力伴前膝痛，6个月后明显好转。术后15例患者经平均2年随访，结果显示平均膝关节活动度92°；膝关节HSS功能评分术后提高至平均86分；无继发感染和畸形发生。结论发现皮肤坏死应尽早清创，坚持适当功能锻炼，仍可获得良好疗效。掌握微创技术可预防切口周围皮缘坏死。

Objectives To analyze the risk factors of derma necrosis around incision after total knee arthroplasty, and explore measures for prevention and treatment. Methods From January 2003 to November 2005, derma necrosis around incison occurred to 15 out of the 382 cases（494 knees）treated by total knee arthroplasty. The data of the 15 cases were analyzed. Preoperative hospital for special surgery knee score （HSS） was 60 points on average. Results All wound were healed after debridement. However, the recover time was over 3 weeks longer than the healing time by first intention. Extensor weakness with anterior knee pain appeared among 9 patients, and 6 months later, the symptoms improved obviously. At two years＇ follow-up, the average range of motion was 92°, and the average HSS improved to 86. There were no secondary infection and deformity in the group. Conclusions It is the key to prevent derma necrosis around incision during total knee arthroplasty that surgeons must accurately grasp technique of minimally invasive surgery for total knee arthroplasty. To acquire satisfactory outcome, it is imperative to perform debridement as soon as possible while the derma necrosis happens. At the same time, it is important to persist in doing adequate functional exercises throughout the period of treatment.