Beller J, Trockel U, Lukoschek M
Orthopädische Klinik, Vincentius-Krankenhaus AG, Konstanz.
Orthopade. 2008 May;37(5):475-80. doi: 10.1007/s00132-008-1257-x.
Peroneal nerve palsy is a rare but distressing complication of total knee arthroplasty (TKA). After introducing a standardised intraoperative and postoperative epidural anaesthesia protocol under otherwise unchanged perioperative management, we noted a sudden cumulation of peroneal nerve palsies after TKA.
In this retrospective study we checked the patients' histories for well-known risk factors for nerve lesions after TKA as well as for those risk factors controversially discussed in the literature.
We found an additive harmful impact of epidural anaesthesia leading to unrecognised pressure on the peroneal nerve, which caused, in combination with a pressure lesion of the pneumatic tourniquet, an axonal lesion in terms of a double-crush syndrome. By lowering the pneumatic tourniquet pressure and carefully positioning the operated leg, we found a clearly reduced risk of nerve lesion while preserving the advantages of epidural anaesthesia for the patient.
To prevent a peroneal lesion after TKA while using continuous epidural anaesthesia, we strongly recommend limiting the pneumatic tourniquet pressure to 320 mmHg while ensuring pressure-free positioning of the operated leg.
腓总神经麻痹是全膝关节置换术（TKA）一种罕见但令人痛苦的并发症。在围手术期管理其他方面不变的情况下引入标准化的术中和术后硬膜外麻醉方案后，我们注意到TKA后腓总神经麻痹突然增多。
在这项回顾性研究中，我们检查了患者病史，以寻找TKA后神经损伤的已知危险因素以及文献中存在争议的危险因素。
我们发现硬膜外麻醉存在累加的有害影响，导致对腓总神经产生未被识别的压迫，这与气压止血带的压迫性损伤相结合，就双压迫综合征而言导致了轴索性损伤。通过降低气压止血带压力并仔细摆放手术肢体的位置，我们发现神经损伤风险明显降低，同时保留了硬膜外麻醉对患者的益处。
为在使用持续硬膜外麻醉时预防TKA后腓总神经损伤，我们强烈建议将气压止血带压力限制在320 mmHg，同时确保手术肢体无受压摆放。
