国人膝关节拉花式松解术中腓总神经的安全性分析

An fvaluation of anatomic risk of peroneal nerve injury with the "Pie Crust" rease during total knee replacement in Chinese

[目的]通过核磁图像测量,评价国人膝关节外翻畸形拉花式松解手术中腓总神经的安全性。[方法]选取连续100例患者(男40例,女60例),在膝关节间隙和胫骨平台以远0.8～1.0cm平面(胫骨截骨的平面)分别测量腓总神经与关节囊内表面和胫骨上端后外侧角骨皮质的距离。进行统计、比较和分析。[结果]在膝关节间隙水平腓总神经距离关节囊内表面1.50cm±0.26cm(0.85～2.23cm);在关节面下8～10cm的胫骨截骨水平,神经距离胫骨上端后外侧角1.40cm±0.27cm(0.80～2.32cm)。相同平面的距离略小于西方人的数据,此安全距离与同平面膝关节处前后外径成正相关。[结论]膝关节外翻畸形拉花式松解手术操作简便可靠,只要切开时刀尖深入不超过0.5cm则一般不会直接损伤腓总神经,如深入超过0.8cm则有可能造成损伤。与西方人相比,国人松解时切入宜稍浅;膝关节处外径偏细的患者切入宜稍浅。

[ Objective] To evaluate the risk of peroneal nerve injury in the “Pie Crust” technique forvalgus release in TKA in Chinese by MRI measurement. [ Method] Axial MR images of 100 knees of the Chinese people were measured at the joint space level and a level of 8 to 10era below the joint line for the proximity of peroneal nerve to the inner surface of joint capsule or the posterolateral corner of proximal tibia. [ Result] The distance between the peroneal nerve to the inner surface of capsule at the joint space level was 1.40 cm±0.27 cm（ 0.80～2.32）cm, and the distance between the peroneal nerve to posterolateral comer of proximal tibia was 1.5 cm±0.26 cm （ 0.85～2.23 ） cm, a little bit smaller than the measurements in westem people. The smaller the AP-diameter of the leg at the measured levels, the shorter the distances were found. [ Conclusion] The peroneal nerve is interposed by the joint capsule,the ligaments and especially the lateral,head of gastrocnemius. It is rather safe if the scalpel is not introduced more deeply than 0.5 centimeter. No much difference in the risk of peroneal nerve injury with this technique in the Chinese people and the Westerners, although the distance measured at the lower level is significantly smaller.