膝关节置换术中腓总神经损伤的原因与预防

Peroneal nerve injury after total knee arthroplasty:assessment of causing and prevention factors

[目的]了解膝关节置换术(TKA)中腓总神经损伤的原因及预防要点。[方法]回顾总结本院1996年1月～2007年6月2000例初次TKA术后腓总神经麻痹患者的致伤原因。6例新鲜完整正常人体下肢标本模拟行TKA术,观察术中容易损伤腓总神经的操作步骤。[结果]9(0.45%)例患者术中腓总神经出现不明原因损伤。标本模拟手术过程证实,术中可能导致腓总神经损伤的高危操作依次为:①松解股骨后外侧关节囊、腓肠肌外侧头时,助手自后向前环抱提拉股骨远端将腓总神经压迫贴近股骨,后外侧骨面大大增加腓总神经挫伤几率,且术后多为其深、浅支同时出现症状。②外侧Hoffman板钩放置位置偏于外侧副韧带后侧或深度过大,钩尖部在运动中容易划伤腓总神经,术后多为深支或浅支的不全损伤。③安装假体试模后,为纠正残余屈曲角度,强力完全伸直或过仰,容易导致腓总神经牵拉伤。[结论]术中松解后外侧关节囊、腓肠肌外侧头时,应该避免助手自后向前环抱股骨远端向上提拉。注意Hoffman板钩位置、插入方向及其深度。避免强力过伸膝关节。

[ Objective] To explore the causing and prevention factors of peroneal nerve injury after total knee arthroplasty （TKA） . [ Method ] Nine postoperative peroneal -nerve injury in 9 patients were documented in a retrospective review of 2000 consecutive total knee arthroplastidS performed at one institution from Jan. 1996 to Jun. 2007. Six fresh cadaver knees were executed TKA to observe the causing factors of peroneal nerve injury in operation. [ Result] The causing factors of the 9 （0. 45% ） patients were not clear. Cadaver knees TKA suggested the dangerous handlings by turns include the belows： ①lifting distal femur by encircle dragging may enhance lesion probability of common peroneal nerve. ②risk for common peroneal nerve to set Hoffman crook not paralleling longitudinal axis of tibia or posterior the lateral collateral ligament. ③excessive straightening knee joint after the prosthesis had been fixed. [ Conclusion] Lifting distal femur by encircle dragging should be avoided while peeling posterolateral joint caps and caput laterale musculi gastrocnemii. The location, inserting orientation and depth of Hoffman crook should be taken care of. Hyperextension of the knee should be avoided.