不同皮肤切口对全膝关节置换术后切口外侧皮肤感觉障碍的影响:前瞻性随机对照研究

Changes of lateral skin sensory loss after total knee arthroplasty through different skin incisions: a prospective randomized control study

背景:膝前正中切口全膝关节置换术(TKA)后大多数患者会出现切口外侧皮肤感觉障碍的情况,目前尚无较好的解决方法;膝前内侧切口行TKA是否能够降低这一情况的发生率及其面积仍不清楚。目的:比较膝前内侧切口与膝前正中切口TKA术后切口外侧皮肤感觉障碍的发生率、面积及其随时间的变化情况。方法:前瞻性连续纳入100例2014年1月至2015年12月初次行单侧TKA的患者,按随机数字表法分为膝前内侧切口组(股内侧肌下入路,51例)和膝前正中切口组(内侧髌旁入路,49例)。记录并比较两组患者的手术时间、切口长度、近端切口距髌骨上缘的距离、远端切口距胫骨结节的距离、切口外侧皮肤感觉障碍的发生率及其面积。结果:两组完成2年期随访的患者各40例。膝前内侧切口组的手术时间较膝前正中切口组有所延长(P=0.041),但在切口长度、近端切口距髌骨上缘的距离和远端切口距胫骨结节的距离均明显优于膝前正中切口组(P<0.001)。膝前内侧切口组术后1周、3个月、1年、2年时切口外侧皮肤感觉障碍的发生率均明显低于膝前正中切口组,差异具有统计学意义(P<0.05)。术后2年,膝前内侧切口组和膝前正中切口组分别有40.0%和32.5%的患者皮肤感觉障碍完全消失,96.6%和89.8%的患者感觉障碍面积缩小,感觉障碍的发生率及面积均呈下降趋势(P<0.05)。结论:膝前内侧皮肤切口可明显降低TKA术后切口外侧皮肤感觉障碍的发生率及其面积,术后膝前皮神经恢复的速度更快、面积更大。

Background:Skin sensory loss often occurs in the lateral incision after total knee arthroplasty(TKA)through midline incision,and there is no satisfying solution.Whether TKA through medial parapatellar incision can reduce the incidence and size of sensory loss is still unclear.Objective:To compare the incidence and area of skin sensory loss in the lateral incision after TKA through medial parapatellar incision versus midline incision.Methods:One hundred consecutive patients who underwent TKA between January 2014 and December 2015 were enrolled in this prospective study.TKA was performed through medial parapatellar approach in 51 patients(medial parapatellar incision group)and through midline approach in 49 patients(midline incision group).The operation time,incision length,distance from proximal incision to the upper edge of patella,distance from distal incision to tibial tubercle,incidence and area of skin sensory loss at lateral incision were recorded and compared at 1 week,3 months,1 year and 2 years after operation.Results:Forty patients in each group finished two-year follow-up.The operation time of medial parapatellar incision group was significantly longer than that of midline incision group(P=0.041),but the length of incision,distance from proximal incision to the upper edge of patella,distance from distal incision to tibial tubercle in medial parapatellar incision group were superior to midline incision group(P<0.001).The incidence and area of skin sensory loss in the medial parapatellar incision group were significantly lower than those in the midline incision group at each point of follow-up(P<0.05).Two years after operation,skin sensory loss completely disappeared in 40.0%patients in the medial parapatellar incision group and in 32.5%patients in the midline incision group;the area of skin sensory loss reduced in 96.6%patients in the medial parapatellar incision group and in 89.8%patients in the midline incision group.Both the incidence and the area of sensory loss showed a downward trend(P<0.05).Conclusions:The medial parapatellar incision can significantly reduce the incidence and area of lateral skin sensory loss after TKA.The knee cutaneous nerve has a faster recovery speed and larger area after TKA.