Primadi Andri, Xu He-Xing, Yoon Taek-Rim, Ryu Je-Hwang, Lee Keun-Bae
Department of Orthopaedics and Traumatology, Universitas Padjadjaran Medical School/Hasan Sadikin Hospital, Bandung, Indonesia.
Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, 42 Jebongro, Donggu Gwangju, 501-757 Republic of Korea.
J Foot Ankle Res. 2015 Oct 2;8:55. doi: 10.1186/s13047-015-0112-7. eCollection 2015.
Neurologic injuries are complications that can arise after total joint arthroplasty. However, no comprehensive study has been conducted on peripheral nerve injuries after total ankle arthroplasty. The purpose of the present study was to identify the prevalence of neurologic injury following primary total ankle arthroplasty, the predisposing factors, and evaluate the effect on clinical outcomes.
We retrospectively analyzed 150 consecutive primary total ankle arthroplasty using the mobile-bearing prosthesis between January 2005 and December 2011, in 150 patients with symptomatic ankle end-stage arthritis. All the patients were divided into groups according to whether they had postoperative peripheral neuropathy (23 patients) or not (127 patients). We investigated the prevalence, predisposing factors, and effect on clinical outcomes of neurologic injuries. The mean age was 61.3 years, and the mean follow-up period was 41.8 months.
There were 23 nerve injuries (15.3 %), including nine in posterior tibial nerves, six superficial peroneal nerves, six deep peroneal nerves, one saphenous nerve, and one sural nerve. Neurologic injury was significantly associated with the development of posttraumatic osteoarthritis, but it was not significantly associated with other predisposing factors, such as age, gender, body mass index, and symptom duration. Of the 23 nerve injuries, 13 (56.5 %) presented a complete, spontaneous recovery, 9 (39.1 %) presented an incomplete recovery, and 1 (4.3 %) presented no recovery. The patients with neurologic injury had significantly lower American Orthopaedic Foot and Ankle Society scores and lower levels of patient satisfaction.
The results of this study suggest that the prevalence of neurologic injury after total ankle arthroplasty is considerable, and that neurologic injury is associated with low levels of patient satisfaction and poor clinical outcomes at mean of 3 years, postoperatively. Care is needed to reduce the occurrence of neurologic injuries.
神经损伤是全关节置换术后可能出现的并发症。然而，尚未对全踝关节置换术后的周围神经损伤进行全面研究。本研究的目的是确定初次全踝关节置换术后神经损伤的发生率、易感因素，并评估其对临床结果的影响。
我们回顾性分析了2005年1月至2011年12月期间连续150例采用活动轴承假体进行初次全踝关节置换的患者，这些患者均患有症状性踝关节终末期关节炎。所有患者根据术后是否发生周围神经病变分为两组（23例患者发生病变，127例患者未发生病变）。我们调查了神经损伤的发生率、易感因素及其对临床结果的影响。患者平均年龄为61.3岁，平均随访期为41.8个月。
共有23例神经损伤（15.3%），其中胫后神经损伤9例，腓浅神经损伤6例，腓深神经损伤6例，隐神经损伤1例，腓肠神经损伤1例。神经损伤与创伤后骨关节炎的发生显著相关，但与年龄、性别、体重指数和症状持续时间等其他易感因素无显著相关性。在23例神经损伤患者中，13例（56.5%）完全自发恢复，9例（39.1%）部分恢复，1例（4.3%）未恢复。发生神经损伤的患者美国矫形足踝协会评分显著较低，患者满意度也较低。
本研究结果表明，全踝关节置换术后神经损伤的发生率相当高，且神经损伤与患者满意度低以及术后平均3年的临床效果不佳相关。需要注意减少神经损伤的发生。
