隐神经髌下支解剖及切除后对膝关节置换术后膝前疼痛的影响

Anatomical Distribution of Infrapatellar Branch of Saphenous Nerve and Effect of Denervation on Anterior Knee Pain after Knee Replacement

目的了解隐神经髌下支的解剖分布,对比分析膝关节置换术中切除隐神经髌下支对术后膝前疼痛的影响。方法对游离的膝关节隐神经髌下支进行解剖。按术中是否切除隐神经髌下支将患者分为两组,对膝关节进行手术前后HSS评分及膝前疼痛自我评分,将两组结果进行统计学分析对比。结果隐神经髌下支分布于膝关节内下方及髌腱的前方。两组患者术前与术后HSS评分和膝前疼痛自我评分比较有显著性差异(P<0.01),但两组间比较无明显差异(P>0.05)。结论隐神经髌下支只是膝前感觉神经的一部分,在膝关节置换术中有意识地将其切除,对于减轻患者术后膝前疼痛的意义不大。

Objective To study the anatomical distribution of the infrapatellar branch of the saphenous nerve and retrospectively analyze the effect of total knee replacement （TKR） or unicompartmental knee replacement （UKR） with denervation of the infrapatellar branch of saphenous nerve on anterior knee pain. Methods The infrapateUar branch of the saphenous nerve of cadavers was observed. The patients were divided into two groups by whether the infrapatellar branch of the saphenous nerve was excisioned. The severity of anterior knee pain was measured with patient visual pain index. The statistical analysis was carried out using SPSS 12.0 for Windows. Data were analyzed using t test. Results There were significant differences in the HSS score and pain score before and after operation （P 〈 0.01）, but there were no significant differences in the HSS score and pain score after operation between the two groups （P 〉 0.05）. The infrap- atellar branch of the saphenous nerve located in the infra and medial area of knee and in the anterior area of patella tendon. Conclusion The infrapatellar branch of the saphenous nerve is only a little part of the sensory nerve of anterior knee joint. The operation of purposely excising the infrapatellar branch of the saphenous nerve is almost meaningless in the knee arthroplasty.