Pan Enhao, Wu Yingbin, Tang Lin, Lu Weijie
Department of Joint Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510120, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 May 15;37(5):635-640. doi: 10.7507/1002-1892.202301071.
To summarize the research progress of anterior cutaneous nerve injury and repair in knee arthroplasty.
The relevant literature at home and abroad in recent years was reviewed and summarized from the anatomy of anterior cutaneous nerve, nerve injury grade, clinical manifestations, prevention and treatment of anterior cutaneous nerve.
The anterior cutaneous nerve injury is a common complication of knee arthroplasty. Because the anterior cutaneous nerve branches are many and thin, and mainly run between the first and second layers of fascia, this level is often ignored during surgical exposure. In addition, the knee arthroplasty does not routinely perform the exploration and repair of the cutaneous nerve. So the anterior cutaneous nerve injury is difficult to avoid, and can lead to postoperative skin numbness and knee pain. At present, studies have explored the feasibility of preventing its occurrence from the aspects of improved incision and intraoperative separation of protective nerve. There is no effective prevention and treatment measures for this complication. For patients with skin numbness after knee arthroplasty, the effectiveness of drug treatment is not clear. Local nerve block or nerve excision can be used to treat patients with painful symptoms after knee arthroplasty considering cutaneous pseudoneuroma.
Knee arthroplasty is widely used and anterior cutaneous nerve injury is common in clinic. In the future, more high-quality clinical studies are needed to further explore the prevention and treatment measures of this complication and evaluate the clinical benefits obtained.
总结膝关节置换术中前皮神经损伤与修复的研究进展。
从膝关节前皮神经的解剖结构、神经损伤分级、临床表现、前皮神经损伤的防治等方面,对近年来国内外相关文献进行回顾总结。
前皮神经损伤是膝关节置换术常见的并发症。由于前皮神经分支多且细,主要走行于筋膜一、二层之间,手术显露时该层面常被忽视。此外,膝关节置换术一般不常规进行皮神经的探查与修复。因此,前皮神经损伤难以避免,且可导致术后皮肤麻木和膝关节疼痛。目前,已有研究从改良切口及术中保护神经分离等方面探讨了预防其发生的可行性。对于该并发症尚无有效的防治措施。对于膝关节置换术后皮肤麻木的患者,药物治疗的效果尚不明确。考虑到皮神经瘤,可采用局部神经阻滞或神经切除治疗膝关节置换术后出现疼痛症状的患者。
膝关节置换术应用广泛,前皮神经损伤在临床上较为常见。未来,需要更多高质量的临床研究进一步探索该并发症的防治措施,并评估所获得的临床效益。