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前交叉韧带重建中腘绳肌腱取材时斜切口与垂直切口的比较及隐神经髌下支损伤情况

A Comparison between Oblique and Vertical Incisions on the Hamstring Tendon Harvesting in Anterior Cruciate Ligament Reconstruction and Infrapatellar Branch Injury of the Saphenous Nerve.

作者信息

Keyhani Sohrab, Kazemi Seyyed Morteza, Sajjadi Mohammadreza Minator, Elmi Asghar

机构信息

Departamento Ortopédico, Shahid Beheshti University of Medical Sciences, Akhtar Hospital, Tehran, Iran.

Departamento Ortopédico, Shahid Beheshti University of Medical Sciences, Taleghani Hospital, Tehran, Iran.

出版信息

Rev Bras Ortop (Sao Paulo). 2020 Jun;55(3):374-379. doi: 10.1055/s-0039-1692695. Epub 2019 Aug 27.

Abstract

The present study aimed to compare the oblique and vertical incisions in hamstring tendon harvesting in anterior cruciate ligament (ACL) reconstruction and in infrapatellar branch injury of the saphenous nerve.  The present study was conducted at a tertiary referral center for 12 months. Patients with an indication of reconstruction of ACL tear were included in the study, who were then randomized into two groups (vertical [VG] and oblique [OG] groups). After excluding a few cases, 92 patients were eligible for further analysis (VG: 44; OG:  48). They were followed-up for 9 months after the surgery, and loss of sensation over the knee and over the proximal aspect of the operated leg was recorded.  The mean lengths of the incisions were 27 mm and 38 mm for the OG and VG groups, respectively. The total rate of hypoesthesia was 40% (27 patients). A total of 12 (25%) and 25 patients (56.8%) on the OG and VG groups, respectively, reported hypoesthesia symptoms. The presence of hypoesthesia in patients in the VG group was two times higher than in the OG group. No statistical correlation was observed between the nerve injury and age, gender, education, and delay from injury to reconstruction.  Oblique incision, which showed lower risk of nerve damage, might be more recommended for graft harvesting. Patients who underwent reconstruction of the ACL in the OG group had a lower incidence of peri-incisional hypoesthesia when compared to those in the VG group.

摘要

本研究旨在比较前交叉韧带(ACL)重建术中腘绳肌腱取材时斜切口与垂直切口以及隐神经髌下支损伤情况。

本研究在一家三级转诊中心进行了12个月。纳入有ACL撕裂重建指征的患者,然后将其随机分为两组(垂直切口组[VG]和斜切口组[OG])。排除少数病例后,92例患者符合进一步分析条件(VG组:44例;OG组:48例)。术后对他们进行了9个月的随访,并记录了膝关节及手术侧小腿近端的感觉丧失情况。

OG组和VG组切口的平均长度分别为27毫米和38毫米。感觉减退的总发生率为40%(27例患者)。OG组和VG组分别有12例(25%)和25例(56.8%)患者报告有感觉减退症状。VG组患者感觉减退的发生率是OG组的两倍。未观察到神经损伤与年龄、性别、教育程度以及受伤至重建的时间间隔之间存在统计学相关性。

斜切口显示出较低的神经损伤风险,在取材时可能更值得推荐。与VG组相比,OG组接受ACL重建的患者切口周围感觉减退的发生率较低。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6e91/7316540/27f76099bc25/10-1055-s-0039-1692695-i1900043en-1.jpg

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