Makhdom Asim, Hamilton Amber A, Rozbruch S Robert
Department of Orthopaedics, King Abdulaziz University, Jeddah, Saudi Arabia.
Weill Cornell Medical College, New York, United States of America.
Strategies Trauma Limb Reconstr. 2022 Jan-Apr;17(1):38-43. doi: 10.5005/jp-journals-10080-1545.
Common peroneal nerve (PN) palsy after total knee arthroplasty (TKA) is a serious complication. Although many authors suggest delayed or immediate PN decompression after TKA in these patients, little is known about the role of prophylactic peroneal nerve decompression (PPND) at the time of TKA. The aim is to report the results of PPND in high-risk patients at the time of TKA.
A multi-institutional retrospective study review of nine patients (10 knees) who underwent PPND at the time of TKA was conducted. Patients who had severe valgus deformities (≥15° of femorotibial angle and not fully correctable by examination under anaesthesia) with or without flexion contractures were included. PPND was performed through a separate 3-4-cm incision at the time of TKA. The demographics, preoperative and postoperative anatomical and mechanical alignments, range of motion, operation time, postoperative neurological function and complications were recorded.
All patients had a completely normal motor and sensory neurological function postoperatively and no complications related to PPND were reported. All patients followed the standard physical therapy protocol after TKA without modifications.The mean preoperative femorotibial angle was 20° (range 15-33°) and the mean postoperative femorotibial angle was 6.3° (range 5-9°) ( = 0.005). The mean preoperative flexion contracture was 9 (range 0-20) and the mean residual contracture was 1.2° (range 2-5°) ( = 0.006).
PPND at the time of TKA is an option to minimise the risk of PN palsy in high-risk patients. This approach can be considered for patients undergoing TKA in selected high-risk patients with a severe valgus deformity.
Makhdom A, Hamilton AA, Rozbruch SR. The Role of Prophylactic Peroneal Nerve Decompression in Patients with Severe Valgus Deformity at the Time of Primary Total Knee Arthroplasty. Strategies Trauma Limb Reconstr 2022;17(1):38-43.
全膝关节置换术（TKA）后腓总神经（PN）麻痹是一种严重的并发症。尽管许多作者建议对这些患者在TKA后进行延迟或即刻的PN减压，但对于TKA时预防性腓总神经减压（PPND）的作用知之甚少。目的是报告TKA时对高危患者进行PPND的结果。
对9例（10膝）在TKA时接受PPND的患者进行了多机构回顾性研究。纳入有严重外翻畸形（股骨胫骨角≥15°且在麻醉下检查不能完全矫正）伴或不伴有屈曲挛缩的患者。在TKA时通过一个单独的3 - 4厘米切口进行PPND。记录人口统计学资料、术前和术后的解剖及力学对线、活动范围、手术时间、术后神经功能和并发症。
所有患者术后运动和感觉神经功能完全正常，未报告与PPND相关的并发症。所有患者TKA后均遵循标准物理治疗方案，未作修改。术前平均股骨胫骨角为20°（范围15 - 33°），术后平均股骨胫骨角为6.3°（范围5 - 9°）（P = 0.005）。术前平均屈曲挛缩为9°（范围0 - 20°），残余平均挛缩为1.2°（范围2 - 5°）（P = 0.006）。
TKA时进行PPND是降低高危患者PN麻痹风险的一种选择。对于有严重外翻畸形的特定高危患者在进行TKA时可考虑这种方法。
Makhdom A, Hamilton AA, Rozbruch SR. 原发性全膝关节置换术时预防性腓总神经减压在严重外翻畸形患者中的作用。《创伤肢体重建策略》2022；17(1):38 - 43。
