全膝关节置换术后腓总神经麻痹的原因及治疗

[目的]探讨全膝关节置换术(TKA)术后腓总神经麻痹产生的原因及治疗。[方法]对1996年1月～2009年12月本院有完整记录的550例初次TKA患者中术后出现腓总神经麻痹的4例患者进行回顾分析,3例随访15个月,1例随访3个月后失访。[结果]术后出现腓总神经麻痹的4例患者(0.91%),2例保守治疗后完全恢复;1例行神经探查松解术后,完全恢复;1例随访3个月感觉功能恢复而运动功能未恢复,继续保守治疗后失访。[结论]TKA术后腓总神经麻痹是多因素造成的,预防是关键,且需重视围手术期相关危险因素的识别并谨慎操作。早期保守治疗效果满意,晚期神经功能恢复差者可行神经探查松解手术。     

膝关节置换术中腓总神经损伤的原因与预防

[目的]了解膝关节置换术（TKA）中腓总神经损伤的原因及预防要点。[方法]回顾总结本院1996年1月～2007年6月2000例初次TKA术后腓总神经麻痹患者的致伤原因。6例新鲜完整正常人体下肢标本模拟行TKA术，观察术中容易损伤腓总神经的操作步骤。[结果]9（0．45％）例患者术中腓总神经出现不明原因损伤。标本模拟手术过程证实，术中可能导致腓总神经损伤的高危操作依次为：①松解股骨后外侧关节囊、腓肠肌外侧头时，助手自后向前环抱提拉股骨远端将腓总神经压迫贴近股骨，后外侧骨面大大增加腓总神经挫伤几率，且术后多为其深、浅支同时出现症状。②外侧Hoffman板钩放置位置偏于外侧副韧带后侧或深度过大，钩尖部在运动中容易划伤腓总神经，术后多为深支或浅支的不全损伤。③安装假体试模后，为纠正残余屈曲角度，强力完全伸直或过仰，容易导致腓总神经牵拉伤。[结论]术中松解后外侧关节囊、腓肠肌外侧头时，应该避免助手自后向前环抱股骨远端向上提拉。注意Hoffman板钩位置、插入方向及其深度。避免强力过伸膝关节。     

肘部尺神经前置术后翻修病例的回顾性分析

目的分析肘部尺神经前置术后翻修手术病例术中探查情况、术后随访治疗效果, 总结尺神经前置初次手术疗效不佳的主要原因以及翻修手术的要点和治疗效果。方法对37例自2008年1月到2019年8月在我院行尺神经前置术后翻修手术的患者进行回顾性分析, 收集病例一般资料、翻修手术前后体格检查、辅助检查(包括神经电生理检查和神经超声)及患者自评量表结果, 记录术中探查情况。结果术后所有患者均获得随访, 时间为4～18个月, 平均(10.3±3.7)个月, 造成尺神经前置初次手术效果不佳的原因主要包括尺神经周围瘢痕组织卡压、局部卡压因素未彻底解除以及筋膜瓣制备不当。翻修术后末次随访时, 手部尺侧麻木改善25例(67.6%)、手部及肘关节尺侧疼痛缓解9例(81.8%)、手内肌萎缩缓解18例(81.8%), 功能评定按照顾玉东肘管综合征功能评定标准:优2例, 良23例, 可10例, 差2例, 优良率达67.6%。影响翻修手术效果的可能相关因素包括初次手术至翻修手术时间以及翻修手术前是否出现严重疼痛。结论尺神经前置初次手术应仔细、谨慎地探查并解除所有可能造成尺神经再次卡压的因素, 并恰当制备用于前置的筋膜瓣。...     

踝关节内翻扭伤致腓总神经损伤的诊治

目的 探讨踝关节内翻扭伤致腓总神经损伤的诊治方法。方法 对２０例踝关节扭伤出现腓总神经损伤症状者行腓总神经探查术,切开减压,松解腓总神经。结果 １５例３个月感觉功能部分恢复,６个月～１年内肌力恢复至４级。结论 踝扭伤出现腓总神经损伤者应作探查松解减压术。     

克罗恩病患者初次手术及术后复发的危险因素分析

目的探讨克罗恩病（CD）患者病程中的初次手术及术后复发的危险因素。方法对中山大学附属第一医院2003-2009年既往无肠切除手术史的216例连续CD病例资料及其随访资料进行回顾性分析。应用Cox比例风险模型分析初次手术的危险因素。应用Logistic回归模型分析术后复发的危险因素。结果在平均55个月的随访期间内．有44例（20．4％）行初次肠切除手术，发病后1年、5年和10年累计手术率分别为11％、25％和45％。多因素分析显示，诊断年龄和疾病行为是初次肠切除手术的独立危险因素（P〈0．05）。44例手术患者有40例接受了平均20．4个月的术后随访，术后1年内镜复发率为52．6％（10／19）；临床复发率为22．5％（9／40），平均临床复发时间为术后22．6个月。多因素分析显示，合并肛周病变是临床复发的独立预测因素（P〈0．05）。2例患者接受了再次肠切除手术，外科复发率为5％（2／40）．再次手术原因均与初次相同。结论cD患者手术率及术后复发率均较高；诊断年龄和疾病行为对初次手术有一定的预测作用：合并肛周病变的患者术后更易出现临床复发。     

手法治愈梨状肌综合征并腓总神经麻痹

手法治愈梨状肌综合征并腓总神经麻痹广西桂林地区医院（５４１００１）覃世才梨状肌综合征并腓总神经麻痹在临床上较少见。１９７７年２月至１９９１年５月我们用手法治愈６例。经近期（４～８个月）及远期（８～１３年）随访各３例，均无复发。报告如下。临床资料本组男...     

初次人工膝关节表面置换术治疗晚期膝关节病的术后并发症分析

目的探讨晚期膝关节病患者应用行初次人工膝关节置换其术后并发症发生情况。方法回顾性分析中山大学附属第一医院关节外科2010年1月1日至2013年12月31日期间住院行初次人工全膝关节表面置换术(TKA)治疗的386例(422膝)晚期膝关节病患者,纳入标准包括:在中山大学附属第一医院诊断为"膝关节骨关节炎"、"类风湿性关节炎"、"膝关节色素绒毛结节滑膜炎""创伤性膝关节炎",行初次全膝关节表面置换术,为期至少4年的随访时间。排除标准包括:使用限制型、铰链式假体;伴有精神、心理疾病史;由于文化、语言、认知等原因不能配合。采用配对t检验统计手术前后膝关节活动度(ROM)。结果截至末次随访时,共有288例(317膝)获得随访,随访率为75.1%,随访时间平均(5.4±1.3)年。术后并发症:2例小腿肌间静脉血栓,2例肺部感染,1例膝关节结周围软组织感染,1例假体周围感染,1例右足干性坏疽,1例金属过敏性皮炎,5例伤口延迟愈合,3例僵直膝(ROM50°),2例外伤后股骨假体周围髁上骨折,1例腓总神经一过性麻痹。患者术前膝关节ROM平均(94±23)°,与末次随访时(104±11)°比较差异有统计学意义(t=2.90,P0.05)。结论 TKA是治疗终末期膝关节病的有效方法,可以明显缓解疼痛,改善功能,纠正关节畸形,做好围手术期处理并发症发生率较低,但要做好对应并发症的及时处理,因此加强患者TKA术后定期随诊具有重要意义。     

非创伤性桡神经麻痹24例临床分析

目的对非创伤性桡神经麻痹的病因,临床表现,治疗结果进行分析。方法自 1985年 1月～ 2000年 1月,共治疗 24例患者,其中男 18例,女 6例;年龄 10～ 65岁,平均 38岁。重体力劳动者及手工劳动者 11例。 1例行肌腱移位术, 23例行桡神经探查,其中 18例行神经松解术, 5例将病变神经段切除（ 2例直接吻合, 3例行游离神经移植）。结果行桡神经探查发现,神经卡压性病变 12例,包括 8例卡压部位位于旋后肌, 1例位于指总伸肌起点腱性部分, 3例多部位多重卡压;神经束带样病变 5例,外在肿物压迫 4例 (2例腱鞘囊肿, 1例脂肪瘤, 1例血管瘤 ),神经肿瘤 1例,不明原因神经病变 1例。 18例神经松解患者术后随访 6个月～ 15年, 14例完全恢复, 1例术后无效, 3例恢复不全; 5例神经吻合或移植患者术后随访 4个月～ 6年, 3例恢复满意, 2例 (1例神经吻合, 1例神经游离移植 )由于术后时间短,仍在恢复中。结论非创伤性桡神经麻痹病因较多,手术治疗效果良好。     

骨关节炎全膝关节置换术中去除或保留腓肠豆的疗效比较

目的比较在全膝关节置换术(TKA)中去除或保留腓肠豆对手术效果的影响。方法自2013年12月至2015年3月期间,对西安市红会医院200例(200膝)膝骨关节炎(OA)KellgrenLawrence分级(K-L分级)Ⅳ级、术前X线片显示均有腓肠豆的患者进行TKA,随机分为腓肠豆去除组和腓肠豆保留组。对比分析两组患者手术时间、术后引流量、视觉模拟评分法(VAS评分)(术后1 d、2 d、3 d、1周、1个月及3个月)、美国特种外科医院(HSS)评分(术后1周、1个月及3个月)以及术后膝关节后外侧疼痛和腓总神经麻痹等指标。在膝外翻病例中,比较两组术中对膝外侧结构的松解程度。计数资料采用卡方检验,计量资料采用Mann-Whitney U进行检验统计。结果术后200例(200膝)OA患者均获得随访,时间3~6个月,平均4个月。两组在手术时间、术后引流量、各时间点VAS评分及HSS评分差异均无统计学意义(P0.05)。OA患者TKA后膝关节后外侧疼痛(6例)及腓总神经麻痹(1例)均发生在腓肠豆保留组。膝外翻病例,腓肠豆保留组10例均需松解后外侧关节囊,而腓肠豆去除组13例中只有8例需松解后外侧关节囊,腓肠豆保留组需对后外侧关节囊的松解更广泛(2=4.91,P0.05)。结论 OA患者在TKA中去除腓肠豆对术后膝关节功能无明显影响,减少术后膝关节后外侧并发症的发生,对膝外翻病例有助于术中软组织的平衡。     

髂胫束松解在外翻膝全膝关节置换术中的作用

目的探讨固定性膝外翻全膝关节置换(TKA)术中髂胫束松解的作用。方法自2009-05—2012-11对22例(24膝)膝关节骨性关节炎并膝外翻畸形行TKA,采用外侧入路,髂胫束多点切开延长松解,Z形切开关节囊,松解髂胫束止点后记录伸直位外翻角度。以股骨及胫骨侧外侧副韧带及腘肌腱为主进一步进行软组织平衡。股骨远端5°~7°外翻截骨,均采用后稳定骨水泥型假体,行髌骨置换。结果本组术中测量髂胫束松解后外翻角平均11.6°(5°~15°),松解前平均27.6°(20°~35°),松解后平均矫正角度为16°。术后恢复良好,未出现腓总神经麻痹。术后外翻角平均6.9°(5°~9°)。22例均获得平均18.9(5~30)个月随访,期间所有患者胫股角稳定,膝关节活动度平均119.2°(100°~125°)。末次随访时,KSS评分平均87.3分,较术前提高62.2分;功能评分平均89.7分,较术前提高65.2分。结论在固定性膝外翻TKA术中,松解髂胫束最大可矫正伸直位外翻20°以内的畸形,改善了髌骨轨迹,明显降低了腓总神经受压麻痹的发生率,不同程度改善了屈曲位外侧间隙紧张。     

Peroneal nerve palsy after total knee arthroplasty

Peroneal nerve palsy after TKA, although uncommon, can be a troublesome complication for patients and surgeons. The predisposing factors must be recognized and meticulous surgical techniques and vigilant postoperative care must be undertaken to minimize their effects. Although effective intervention still remains to be determined, most patients do proceed to complete recovery from the nerve palsy but demonstrate good functional capacity.To our knowledge, there are no prospective studies that clearly elucidate the effect of the previously mentioned risk factors on the incidence of peroneal nerve palsy after TKA. More research is needed to tease out these risk factors and explore treatment strategies. A prospective randomized controlled study may help determine the optimal treatment strategy for this important clinical problem.     

Common peroneal nerve palsy: an unexpected complication of liver surgery

BACKGROUND: Common peroneal nerve palsy is a well-recognized complication following surgery in lithotomy position, particularly colorectal and gynecologic surgery. But it is quite rare after liver surgery because patients are usually placed in supine position. CASE REPORT: There were three cases of common peroneal nerve palsy after liver surgery in the past 2 years, including two cases of liver transplantation and one case of extended right hepatectomy. Two cases were bilateral and one case was unilateral. They were placed in supine position and the mean operative time was 8 hours. Patients complained symptom of foot drop within 1 week after operation. Electromyographic examinations showed evidence compatible with common peroneal nerve palsy. All of them improved with conservative treatment within 6 months. CONCLUSION: Common peroneal nerve palsy may develop after liver surgery even in supine position. Injury to common peroneal nerve should be a concern before and during the operation. This complication could be managed conservatively with an uneventful result.     

Common Peroneal Nerve Palsy Due to Giant Fabella After Total Knee Arthroplasty

BackgroundCommon peroneal nerve palsy (CPNP) is a rare but serious complication following primary total knee arthroplasty (TKA). The common peroneal nerve is one of the main molecules of the sciatic nerve. CPNP is a series of symptoms caused by common peroneal nerve injury due to paralysis and atrophy of the fibula and tibia muscles. The main clinical symptoms are: ankle joint unable to extend back, toe unable to extend back, foot droop, walking in a steppage gait, and foot dorsal skin sensation having decreased or disappeared. If treatment is not timely, severe cases may result in atrophy of the anterior tibia and lateral calf muscles. The risk factors for CPNP include mechanical stretching of the nerve, disruption of the blood supply to the nerve, and compression of the nerve. The CPNP should be treated in a timely manner and according to the cause. Its function should be restored as soon as possible to avoid serious adverse consequences. It has negative effects on patients’ life and physical and mental health. To our knowledge, this is the first study to describe CPNP due to a giant fabella after TKA.Case presentationThe present study reported on a 70‐year‐old female patient. The patient underwent a primary TKA of the right knee for osteoarthritis. Relevant examinations were conducted and the operation went smoothly. Three hours postoperation, a right partial CPNP was observed, with progressive aggravation over time. On palpation, there was a 2 × 2‐cm fixed hard mass in the posterolateral aspect of the right knee, with mild tenderness to deep palpation. Radiographs demonstrated that a giant fabella was located at the posterolateral condyle of the right femur. Fabellectomy and neurolysis of the common peroneal nerve were performed. The peroneal nerve palsy resolved gradually after the operation. At 8‐month follow up after fabellectomy and neurolysis, the function of the common peroneal nerve had fully recovered.ConclusionsThe presence of giant feballa pressing on the common peroneal nerve should be considered when common peroneal nerve palsy occurs after TKA. Surgical exploration and release compression should be performed in a timely manner.     

Common Peroneal Nerve Palsy Following Total Knee Arthroplasty : Prognostic Factors and Course of Recovery

Common peroneal nerve palsy (CPNP) is a serious complication following total knee arthroplasty (TKA). There is little information regarding the clinical course and prognostic factors for recovery. Between January 2000 and December 2008, 44 patients (0.53%) developed CPNP following TKA and were matched to 100 control patients based on year of surgery, type of surgery and surgeon. Regression analysis was performed to identify prognostic factors for recovery. A significant difference was seen in CPNP patients who were on average younger (62.1 years) and had higher BMI (34.5 kg/m²) than those who did not have nerve palsy (67.5 years and 31.8 kg/m², respectively). Only 37 patients with palsies could be followed, 32 (62.2%) had incomplete nerve palsy, twenty four (75%) of them fully recovered, while only 1 of patients with complete nerve palsy fully recovered. More severe initial injury was a negative prognostic factor for recovery of palsy (P < 0.03).     

Nerve injury after primary total knee arthroplasty

There is controversy about the incidence of and predisposing factors to the development of peripheral nerve palsy after total knee arthroplasty (TKA). In this study, 19 patients with a documented neurologic complication were identified after a retrospective review of 1,476 primary TKAs performed between January 1970 and December 1998 at the New York Presbyterian Hospital at Columbia University, for an overall incidence of 1.3%. Contrary to previously published data, valgus deformity, flexion contracture, the use of postoperative epidural anesthesia, the prolonged use of pneumatic tourniquets, and preexisting neuropathy were not associated with the development of peripheral neuropathy after TKA based on our data. A larger percentage of rheumatoid knees experienced a neurologic injury than was expected, however. No other significant risk factors for peripheral neuropathy after TKA were identified based on data from our patients. Immediately after discovery of the nerve palsy, conservative treatment was employed for each of our patients. All patients showed at least a partial recovery at the end of follow-up, with most experiencing a complete recovery from symptoms.     

人工膝关节置换治疗膝外翻畸形的疗效

目的探讨全膝关节置换治疗膝关节外翻畸形的技术方法和临床效果。方法 2006年2月至2010年4月收治12例12膝外翻畸形患者,8例骨关节炎和4例类风湿性关节炎,应用人工全膝关节置换手术治疗。根据X线片比较术前和术后膝外翻角度,应用HSS膝关节评分系统进行临床效果评价。结果术后切口均一期愈合,无感染,无腓总神经麻痹发生;随访6~34个月,平均19个月;术前膝外翻角度13°~35°,平均(19.8±3.3)°,术后膝外翻角度4.9°~9.5°,平均(6.4±1.4)°,与术前比较差异有统计学意义(P0.05);术前HSS评分为31~63分,平均(38.0±2.7)分,术后末次随访膝关节HSS评分为78~89分,平均(84.0±2.9)分,与术前比较差异有统计学意义(P0.05)。结论人工全膝关节置换是膝关节炎合并外翻畸形的有效治疗方法。     

Postarthroplasty "palsy" and systemic neuropathy: a peripheral-nerve management algorithm

Postarthroplasty palsy, occurrence of dysfunction of the sciatic or peroneal nerve after total joint replacement of the hip or knee, is a complication that remains poorly understood. Characteristics of a series of 24 patients with postarthroplasty palsy are reviewed, with the finding that, overall, 58.4% of the patients had an underlying peripheral neuropathy. The role of this neuropathy predisposing the arthroplasty patient to stretch/traction injury is discussed and should be emphasized as a risk factor prior to surgery and should influence the surgeon's intraoperative use of force during the arthroplasty procedure. This clinical problem is addressed from the perspective of peripheral nerve surgery, with an algorithm suggested for its management. The algorithm suggests that if a peroneal palsy is still present at 3 months after an arthroplasty and neurosensory testing fails to demonstrate a sensory reinnervation pattern in the territories of the deep or superficial peroneal nerve, then surgical neurolysis of the common peroneal nerve is indicated.     

Peroneal nerve palsy after total knee arthroplasty

The prognosis for peroneal palsy after total knee arthroplasty (TKA) is poorly defined. Twenty-six postoperative peroneal palsies occurred after 8998 TKAs performed between 1972 and 1985. Eighteen patients had complete and eight had incomplete peroneal palsies. Twenty-three had both motor and sensory deficits, and three had only motor deficits. At an average of 5.1 years (range, one to 11 years) after arthroplasty, recovery was complete for 13 palsies and partial for 12. Complete recovery was more likely in those palsies that were incomplete initially. Patients with palsies that were initially partial had significantly higher knee scores than those with complete palsies, and patients whose eventual recovery was complete had significantly higher knee scores than those with incomplete recovery. This new prognostic information should be useful for surgeons who encounter this unfortunate yet persistent complication of TKA.     

Peronäusläsionen nach KTEP-Implantation unter Verwendung einer postoperativ fortgeführten periduralen Analgesie

BACKGROUND: Peroneal nerve palsy is a rare but distressing complication of total knee arthroplasty (TKA). After introducing a standardised intraoperative and postoperative epidural anaesthesia protocol under otherwise unchanged perioperative management, we noted a sudden cumulation of peroneal nerve palsies after TKA. PATIENTS AND METHODS: In this retrospective study we checked the patients' histories for well-known risk factors for nerve lesions after TKA as well as for those risk factors controversially discussed in the literature. RESULTS: We found an additive harmful impact of epidural anaesthesia leading to unrecognised pressure on the peroneal nerve, which caused, in combination with a pressure lesion of the pneumatic tourniquet, an axonal lesion in terms of a double-crush syndrome. By lowering the pneumatic tourniquet pressure and carefully positioning the operated leg, we found a clearly reduced risk of nerve lesion while preserving the advantages of epidural anaesthesia for the patient. CONCLUSION: To prevent a peroneal lesion after TKA while using continuous epidural anaesthesia, we strongly recommend limiting the pneumatic tourniquet pressure to 320 mmHg while ensuring pressure-free positioning of the operated leg.     

Peroneal nerve palsy due to rare reasons: a report of three cases

Peroneal nerve entrapment was diagnosed in three patients (2 males, 1 female) by clinical and electrophysiological studies. Of these, one patient had postural bilateral involvement due to prolonged squatting, while two patients had mechanically-induced entrapment. Initially, all the patients were treated conservatively with a drop-foot splint and vitamin B. One patient responded to treatment; in one patient with bilateral involvement, right-sided peroneal nerve palsy improved. Upon detection of no clinical and electrophysiological improvement after three months of conservative treatment, surgical decompression was performed in two patients, which resulted in a successful outcome in the patient with bilateral palsy. Incomplete recovery was obtained in the other patient with diabetic polyneuropathy.