去神经化治疗膝关节置换后膝关节顽固性疼痛

Denervation therapy for intractable pain of knee joint after total knee arthroplasty

背景:国内关于膝关节周围皮神经的解剖研究较少,国内治疗膝关节置换后顽固性疼痛多采用翻修手术或长期服用药物缓解疼痛,但这方法并不能有效缓解患者的术后疼痛。2种目的:通过对膝关节的解剖,明确人体膝关节周围皮神经分布,探究去神经化方案对膝关节置换后膝关节顽固性疼痛患者的治疗效果。方法:对2具成年防腐尸体和2具新鲜成年尸体进行解剖,观察膝骨关节周围皮神经组织分布。选择全膝关节置换后膝关节顽固性疼痛患者100例,随机分为2组,每组50例。观察组根据解剖结果进行去神经化治疗,对照组采用药物治疗。对患者进行术后随访,采用骨关节指数评估患者膝关节功能,采用健康调查简易量表(SF-36)评估生活质量,采用目测类比评分评估疼痛情况,并记录不良反应。结果与结论:(1)膝关节周围的皮神经分布较为固定,且各个皮神经均有较为明确的骨性标志,可以为有关手术提供解剖依据;(2)术后观察组患者目测类比评分显著低于对照组(P<0.05);(3)术后1,3,6,12个月,观察组患者的骨关节指数较对照组低,健康调查简易量表SF-36评分较对照组高(P<0.05);(4)观察组患者术后出现3例关节肿胀,对照组患者2例出现关节肿胀,2组比较差异无显著性意义(P>0.05);(5)通过尸体解剖可明确膝关节周围皮神经的解剖分布,在此基础上进行的去神经化治疗能够有效改善膝关节置换后膝关节顽固性疼痛患者的疼痛症状和骨关节质量,提高患者的生活质量,且具有较好的安全性。

BACKGROUND： Anatomical studies on cutaneous nerve around the knee are less in China. Revision surgery or long-term use of medication is commonly used for intractable pain after knee replacement. However, these methods cannot effectively relieve postoperative pain. OBJECTIVE： To explore the therapeutic effect of denervation scheme on intractable pain in patients with knee joint pain after knee replacement through identifying the distribution of the cutaneous skin around the knee joint in the study of anatomy of the knee joint. METHODS： Two adult cadavers and two fresh adult cadavers were dissected to observe the distribution of cutaneous nerves around the knee joint. 100 cases of knee joint of patients with intractable pain after total knee arthroplasty were randomly divided into two groups （n=50）. Patients in the observation group underwent denervation scheme. Patients in the control group underwent drug treatment. Patients were followed up after surgery. Bone joint index score was used to evalt^ate the knee joint function. 36-Item Short-Form Health Survey （SF-36） was utilized to evaluate the quality of life. Visual analogue scale was employed to assess the patient＇s pain. Adverse reactions were recorded. RESULTS AND CONCLUSION＂ （1） Distribution of cutaneous nerves around the knee was fixed. Moreover, each cutaneous nerve had a more definite bony landmark, and could provide anatomic basis for related surgery. （2） Visual analogue scale scores were significantly lower in the observation group than in the control group （P 〈 0.05）. （3） Bone joint index score was lower, but SF-36 scores were higher in the observation group than in the control group at 1,3, 6 and 12 months after surgery （P 〈 0.05）. （4） Three cases affected joint swelling in the observation group and two cases suffered from joint swelling in the control group. No significant difference in joint swelling was detected between the two groups （P 〉 0.05）. （5） Necroscopy could identify anatomical distribution of cutaneous nerve around the knee. On this basis, denervation therapy can effectively improve symptoms and bone quality in patients with intractable pain, improve the quality of life of patients, and have better safety.