Department of Orthopaedic Surgery, Rangueil Hospital Center, Toulouse, France.
Clin Orthop Relat Res. 2011 Nov;469(11):3154-63. doi: 10.1007/s11999-011-1973-0. Epub 2011 Jul 15.
The anterior midline skin incision in a TKA provides excellent surgical exposure. However, it usually requires sectioning the infrapatellar branch of the saphenous nerve which may be associated with lateral cutaneous hypesthesia and neuroma formation.
QUESTIONS/PURPOSES: We asked whether an anterolateral skin incision to the knee would decrease the area of skin hypesthesia and associated postoperative discomfort.
We randomized 69 knees to receive a TKA through either a midline or an anterolateral skin incision. We assessed skin sensitivity by application of the Semmes-Weinstein monofilament at 13 reference points at 6 weeks and 6 and 12 months postoperatively. The area of hypesthesia was measured using Mesurim Pro 9(®) software. Patient knee ROM, Knee Injury and Osteoarthritis Outcome Score (KOOS), and WOMAC clinical score also were assessed.
The area of hypesthesia was less after an anterolateral compared with a midline incision up to 1 year after surgery: the areas of hypesthesia were, respectively, 32 cm(2) versus 76 cm(2) at 6 weeks, 14 cm(2) versus 29 cm(2) at 6 months, and 7 cm(2) versus 19 cm(2) at 1 year. Clinical scores and knee ROM were similar in both groups at each followup. At 1 year, in the entire group we observed a correlation between a smaller area of paresthesia and better WOMAC and KOOS scores and greater knee flexion.
Compared with the midline skin incision, the anterolateral incision is associated with fewer sensory disturbances and appears to be a reasonable alternative in TKA.
Level I, therapeutic study. See the guidelines for authors for a complete description of levels of evidence.
TKA 的前中线皮肤切口提供了极佳的手术显露。然而，它通常需要切断隐神经的髌下支，这可能与外侧皮肤感觉减退和神经瘤形成有关。
问题/目的：我们想知道膝关节前外侧皮肤切口是否会减少皮肤感觉减退区域和相关的术后不适。
我们将 69 例膝关节随机分为接受中线或前外侧皮肤切口的 TKA。我们使用 Semmes-Weinstein 单丝在术后 6 周、6 个月和 12 个月的 13 个参考点评估皮肤敏感性。使用 Mesurim Pro 9(®)软件测量感觉减退区域。还评估了患者的膝关节活动度、膝关节损伤和骨关节炎结果评分（KOOS）以及 WOMAC 临床评分。
与中线切口相比，前外侧切口在术后 1 年内感觉减退区域更小：术后 6 周时分别为 32cm²和 76cm²，6 个月时分别为 14cm²和 29cm²，1 年时分别为 7cm²和 19cm²。两组在每次随访时的临床评分和膝关节活动度均相似。在 1 年时，在整个组中，我们观察到感觉减退区域较小与 WOMAC 和 KOOS 评分更好以及膝关节屈曲度更大之间存在相关性。
与中线皮肤切口相比，前外侧切口与较少的感觉障碍相关，并且似乎是 TKA 的合理替代方法。
I 级，治疗研究。有关证据水平的完整描述，请参见作者指南。
