Liu H W, Xu J, Lin Y, Luo F Q, Yu Y L
Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation, Fujian University of TCM, Ministry of Education, Fuzhou 350001, China.
Department of Orthopedics, Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, China.
Zhonghua Yi Xue Za Zhi. 2020 Feb 25;100(7):516-520. doi: 10.3760/cma.j.issn.0376-2491.2020.07.008.
To investigate the clinical efficacy of common peroneal nerve "pre-release" to avoid nerve palsy in total knee arthroplasty for severe valgus deformities. Twenty patients (22 knees) with severe valgus deformities were prospectively and continuously included in Fujian Province Hospital from January 2010 to January 2016. Medial parapatellar arthrotomy, femoral distal resection using the intramedullary cutting guide with 3° to 5° of valgus and the common peroneal nerve "pre-release" was performed, the patella was routinely resurfaced. A common peroneal nerve checking was performed (LSUHSC system), then, these outcomes were collected independently using visual analogue scale (VAS) of pain, Knee Society Score (KSS), Hospital for Special Surgery Knee Score (HSS), range of motion of knees (ROM), femorotibial angle (FTA), hip-knee-ankle angle (HKA), condylar-hip angle (CHA), plateau- ankle angle (PAA). The paired test was used to compare the data before and after the operation. Patients were followed up for 18 to 55 (mean, (38±8) months). According to Krackow's classification, all cases were typed Ⅱ. All the patients had a completely normal motor (grade 5) and sensory (LSUHSC score was 5) nerve function of common peroneal nerve postoperatively. No decrease or loss in muscle strength and cutaneous sensation associated with common peroneal nerve was found. The VAS of pain, KSS, HSS, ROM, HKA, CHA, and PAA were all improved after the operation when compared with those before the operation (21.602, -70.238, -82.455, -20.560, 16.058, 9.682, 3.439, all 0.05). The alignment of lower limbs was corrected basically, and the FTA decreased from 31.7°±8.0° before operation to 5.0°±2.0° at the last follow-up, the differences was statistically significant (16.725, 0.05). No common peroneal nerve palsy and transient or late-onset palsy occurred, and no revision was needed for instability during the follow-up in all the patients. Common peroneal nerve "pre-release" for severe valgus knees may be an effective method in protecting the nerve.
探讨腓总神经“预松解”在重度膝外翻畸形全膝关节置换术中预防神经麻痹的临床疗效。2010年1月至2016年1月前瞻性连续纳入福建省立医院20例（22膝）重度膝外翻畸形患者。采用髌旁内侧入路，使用外翻3°至5°的髓内切割导向器进行股骨远端截骨，并进行腓总神经“预松解”，髌骨常规进行表面置换。进行腓总神经检查（LSUHSC系统），然后独立收集疼痛视觉模拟评分（VAS）、膝关节协会评分（KSS）、特种外科医院膝关节评分（HSS）、膝关节活动范围（ROM）、股胫角（FTA）、髋膝踝角（HKA）、髁髋角（CHA）、平台踝角（PAA）等结果。采用配对t检验比较手术前后的数据。患者随访18至55个月（平均（38±8）个月）。根据Krackow分类，所有病例均为Ⅱ型。所有患者术后腓总神经运动功能完全正常（5级），感觉功能（LSUHSC评分为5分）。未发现与腓总神经相关的肌肉力量和皮肤感觉下降或丧失。与术前相比，术后疼痛VAS、KSS、HSS、ROM、HKA、CHA和PAA均有改善（分别为21.602、-70.238、-82.455、-20.560、16.058、9.682、3.439，均P<0.05）。下肢力线基本矫正，FTA从术前的31.7°±8.0°降至末次随访时的5.0°±2.0°，差异有统计学意义（P=16.725，P<0.05）。所有患者随访期间均未发生腓总神经麻痹及短暂性或迟发性麻痹，也无需因不稳定进行翻修。对于重度膝外翻膝关节，腓总神经“预松解”可能是一种有效的神经保护方法。
