全膝关节置换术后围手术期神经损伤：20 年队列研究中的区域麻醉风险。

Perioperative nerve injury after total knee arthroplasty: regional anesthesia risk during a 20-year cohort study.

机构信息

Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

出版信息

Anesthesiology. 2011 Feb;114(2):311-7. doi: 10.1097/ALN.0b013e3182039f5d.

DOI:10.1097/ALN.0b013e3182039f5d

PMID:21239974

Abstract

BACKGROUND

Perioperative nerve injury (PNI) is one of the most debilitating complications after total knee arthroplasty (TKA). Although regional anesthesia (RA) techniques reduce pain and improve functional outcomes after TKA, they may also contribute to PNI. The objective of this study was to test the hypothesis that PNI risk differs among patients according to RA use during TKA.

METHODS

All patients aged at least 18 yr who underwent elective TKA from January 1988 to July 2007 were retrospectively identified. The primary outcome variable was the presence of a new PNI documented within 3 months of the procedural date. Age, sex, body mass index, type of procedure, tourniquet time, type of anesthesia, and use of peripheral nerve blockade were evaluated as potential risk factors for PNI using multivariable logistic regression.

RESULTS

Ninety-seven cases of PNI were identified among 12,329 patients. Overall incidence of PNI was 0.79% (95% CI, 0.64-0.96%). PNI was not associated with peripheral nerve blockade (odds ratio [OR], 0.97) or type of anesthesia (OR, 1.10 [neuraxial vs. general]; OR, 1.82 [combined vs. general]). Risk for PNI decreased with age (OR, 0.68 [per decade]; P < 0.001) but increased with tourniquet time (OR, 1.28 [per 30-min increase]; P = 0.003) and bilateral procedures (OR, 2.51; P < 0.001). Patients with PNI who underwent peripheral nerve blockade were less likely to have complete neurologic recovery (OR, 0.37; P = 0.03).

CONCLUSIONS

Risk for PNI after TKA was unchanged by the use of RA techniques. This finding supports the notion that the known benefits of RA for patients undergoing TKA can be achieved without increasing risk of neurologic injury. However, in rare situations when PNI occurs, complete recovery may be less likely if it develops after peripheral nerve blockade.

摘要

背景

围手术期神经损伤（PNI）是全膝关节置换术（TKA）后最致残的并发症之一。尽管区域麻醉（RA）技术可减轻 TKA 后的疼痛并改善功能结果，但它们也可能导致 PNI。本研究旨在检验假设，即在接受 TKA 时使用 RA 的患者中，PNI 的风险存在差异。

方法

回顾性确定了 1988 年 1 月至 2007 年 7 月期间接受择期 TKA 的所有至少 18 岁的患者。主要结局变量是在程序日期后 3 个月内记录的新 PNI 的存在。使用多变量逻辑回归评估年龄、性别、体重指数、手术类型、止血带时间、麻醉类型以及周围神经阻滞的使用等作为 PNI 的潜在危险因素。

结果

在 12329 例患者中发现了 97 例 PNI。PNI 的总体发生率为 0.79%（95%CI，0.64-0.96%）。PNI 与周围神经阻滞（比值比[OR]，0.97）或麻醉类型（OR，1.10[神经轴 vs. 全身]；OR，1.82[联合 vs. 全身]）无关。PNI 的风险随年龄的增加而降低（OR，0.68[每十年]；P <0.001），但随止血带时间的增加（OR，1.28[每增加 30 分钟]；P = 0.003）和双侧手术（OR，2.51；P <0.001）而增加。接受周围神经阻滞的 PNI 患者完全神经恢复的可能性较小（OR，0.37；P = 0.03）。