Joshi A, Kayasth N, Shrestha S, Kc B R
Shree Birendra Hospital, Nepalese Army Institute of Health Sciences, Chhauni, Kathmandu, Nepal.
Armed Police Force Hospital, Kathmandu, Nepal.
J Nepal Health Res Counc. 2016 Sep;14(34):180-185.
Autologous hamstring grafts are commonly used for anterior cruciate ligament reconstruction. The injury of infrapatellar branch of saphenous nerve is one of the concerns leading to various pattern of sensory loss in the operated leg. An oblique incision to harvest the graft has been reported to be better than the vertical one.The aim of this study was to compare the incidence, recovery of nerve injury and final outcome in patients with hamstring harvest of vertical or oblique incision.
A total of 146 patients who underwent hamstring graft harvest for anterior cruciate ligament reconstruction, were included in the study. They were randomized into two (Vertical and Oblique) groups as per the incisions used. The sensory loss along the Infra Patellar Branch of Saphenous Nerve was documented on 3rd day. Recovery of the nerve injury was monitoredat three, six and 12 months follow-ups. At final follow up Tegner Lysholm score and scale was recorded to compare between two groups.
The incidence of infrapatellar branch of saphenous nerve injury was 25% in vertical group and 16.36% in oblique group. Recovery of nerve injury started earlier in oblique group compared to vertical group. The mean TegnerLyshom score was not significantly different in both the groups.
Oblique incision to harvest hamstring graft has lesser incidence of infrapatellar branch of saphenous nerve injury, recovers earlier and does not have any adverse effect on final outcome compared to the vertical incision.
自体腘绳肌腱移植物常用于前交叉韧带重建。隐神经髌下支损伤是导致患侧出现各种感觉丧失模式的问题之一。据报道，采用斜切口获取移植物比垂直切口更好。本研究的目的是比较采用垂直或斜切口获取腘绳肌腱的患者中神经损伤的发生率、恢复情况及最终结果。
本研究纳入了146例行前交叉韧带重建并采用腘绳肌腱移植物获取术的患者。根据所使用的切口将他们随机分为两组（垂直组和斜组）。在术后第3天记录隐神经髌下支沿线的感觉丧失情况。在术后3个月、6个月和12个月随访时监测神经损伤的恢复情况。在末次随访时记录Tegner Lysholm评分及量表，以比较两组之间的差异。
垂直组隐神经髌下支损伤的发生率为25%，斜组为16.36%。与垂直组相比，斜组神经损伤的恢复开始得更早。两组的平均Tegner Lyshom评分无显著差异。
与垂直切口相比，采用斜切口获取腘绳肌腱移植物时，隐神经髌下支损伤的发生率更低，恢复更早，且对最终结果没有任何不利影响。
