膝关节置换术后切口周围皮肤麻木的研究

Dermal hypoesthesia after total knee arthroplasty

目的:观察前正中切口行膝关节置换术(total knee arthroplasty,TKA)后切口周围皮肤麻木的发生率及其面积随时间的变化情况,研究麻木面积大小与切口长度、止血带时间、患者年龄等因素间的关系。方法:回顾性选取距调查时间4年、3年、2年、1年、6个月、1个月以前正中切口行TKA术的132例患者(135例膝关节),所有患者术前均无膝关节周围皮肤麻木。所有手术均由同一组医生完成,使用假体分别为Stryker NRG和DepuyRP(不做髌骨置换)。统计所有患者切口周围皮肤麻木的发生率及麻木面积,统计各切口长度、止血带时间等。结果:TKA术后发生切口周围皮肤麻木的比例是84.44%,其中91.22%的患者的麻木面积随着时间推移而逐渐缩小,从术后1个月组至术后4年组,患者膝关节切口周围皮肤麻木面积均值呈减小趋势(P<0.001)。以术后1个月麻木面积为标准,至术后2年切口周围皮肤麻木面积的减小差异有统计学意义(P值分别为0.042、0.004、0.022),术后2年至4年间麻木面积的变化不大(P>0.05)。88.60%的患者麻木区完全在切口的外侧,11.40%的患者麻木区的下部越过切口远端至切口内侧。麻木面积大小与患者性别、年龄、切口长度、止血带时间均无明显关系(P>0.05)。结论:绝大部分患者行TKA术后会出现切口周围皮肤麻木,麻木面积随时间推移逐渐缩小;至术后2年,膝关节皮肤麻木面积的大小变化不大,趋于稳定。患者性别、年龄、切口长度、止血带时间与麻木面积的大小无明显关系。

Objective：To observe the incidence of skin sensory loss after total knee arthroplasty（TKA） and its natural history over time,and to identify the relationship between numbness area and incision length,tourniquet time,age and gender.Methods：In the study,132 patients（20 males and 112 females,with an average age of 69.75 years old,135 cases of TKA） who underwent primary TKA with midline incisions were chosen and grouped chronologically（4 years,3 years,2 years,1 year,6 months,1 month） to the investigation time point from Peking University First Hospital.All the operations were done by the same surgeon team with Stryker NRG and Depuy RP（without patellar resurfacing）.Numbness incidence,numbness area,scar length,tourniquet time were recorded from the questionnaires sent to the patients and their medical records.Results：84.44% of the patients received a reduced skin sensory after TKA,91.22% of which had a smaller numbness area gradually over time.The numbness area was decreased from the 1 month post-operation group to the 4 years post-operation group（P 0.001）.The numbness area in 2 years post-operation group and more were significantly smaller than 1 month post-operation group（P=0.042,0.004,0.022）,however,the skin flap numbness area had little change after 2 years（P0.05）.The hypoesthesia flap was completely lateral to the incision in 88.60% of the patients,and the numbness area covered the lateral skin and part of media skin to the incision in 11.40% of the patients.Numbness size had no relationship with the patients＇ gender,age,length of scar and tourniquet time（P0.05）.Conclusion：Most but not all the patients have a dermal hypoesthesia after total knee arthroplasty.The numbness area will gradually reduce over time.Numbness size is obviously smaller 2 years post-operation and then it will be stable.Gender,age,length of incision,and tourniquet time have no significant relationship with the size of numbness.