摘要
目的:探讨膝关节前交叉韧带(ACL)重建术取腱切口方向与隐神经髌下支损伤的关系。方法:以2005年1月至2005年3月间行膝关节前交叉韧带重建术后取内固定术的60例患者为研究对象。ACL重建术中取腱切口方向为纵行者35例,斜行者25例。术后取钉时间9～31个月,平均14.5±4.72个月。测量手术切口疤痕长度。令29例存在小腿皮肤感觉障碍的患者将障碍区域标出,测量其面积,并做相应的象限分析。解剖15具尸体的膝关节,测量其隐神经髌下支与鹅足腱上缘的距离。结果:纵行切口组与斜行切口组手术切口疤痕长度无显著性差异。纵行切口组皮肤感觉有障碍者23例(65.7%),斜行切口组6例(24.0%),纵行切口患者术后更易出现小腿皮肤感觉障碍(P<0.001)。尸体膝关节解剖结果显示隐神经髌下支走行与鹅足腱上缘近似平行(由内上至外下),二者之间距离平均为0.6cm。结论:膝关节前交叉韧带重建术纵行切口取腱较斜行切口更易损伤隐神经髌下支,术后患者易出现患肢小腿皮肤感觉障碍。术前有必要告知患者隐神经髌下支损伤是ACL重建术常见并发症之一。
Objective To investigate the relation of the incision direction to the injury of the infrapatellar branch of the saphenous nerve （IPBSN） during anterior cruciate ligament （ACL） reconstruction. Methods This study was conducted retrospectively and comparatively. ACL reconstruction was performed in 60 patients with hamstring tendon graft. Hardware used for fixation was removed 9 - 31 months （average 14.5 ＋ 4.72 months ） after ACL reconstruction. Vertical incision was used in thirty - five patients and oblique incision in twenty - five patients. The patients were to asked to mark the sensory disturbance zone around the surgical incision and then the area measured. In addition, 15 cadavers knee - joint were anatomized. The distances between the IPBSN and the upper edge of the pes anserinus tendon were measured. Results There was no significant difference between the 2 groups＇ incision length. 23 Patients （65.7%） with a vertical incision had evidence of IPBSN damage as compared to 6 patients （24.0%） with oblique incision. IPBSN more easily occurred in patients with a vertical incision during ACL reconstruction （ P 〈 0.001）. Moreover, the cadaver knee - joint anatomy suggested that the IPBSN was almost paralleled to the upper edge of the pes anserinus tendon, and the average of distance between them was 0.6cm. Conclusion An oblique incision may be an useful option for ACL graft harvesting with less risk of IPBSN damage. Regardless of the incision used, damage to the IPBSN was one of the potential complications of the surgery and patients should be counseled preoperatively.
出处
《中国运动医学杂志》
CAS
CSCD
北大核心
2006年第3期294-296,i0004,i0005,共5页
Chinese Journal of Sports Medicine
基金
北京大学医学部"985"工程Ⅱ期建设项目资助
关键词
前交叉韧带
重建术
隐神经
神经损伤
anterior cruciate ligament, reconstruction, saphenous nerve, nerve injury
