初次全膝关节置换术后腓总神经麻痹的原因及处理

目的探讨初次全膝关节置换术（TKA）术后腓总神经麻痹产生的原因及处理。方法对2002年1月至2009年12月本院有完整记录的1257例初次TKA患者中术后出现腓总神经麻痹的病例进行回顾分析并随访14～56个月,其中一期双侧TKA 4例,单侧TKA 2例;术前诊断骨关节炎3例,类风湿关节炎2例,血友病关节炎1例。结果 6例（0.47%）术后出现腓总神经麻痹,可能的原因包括术中拉钩位置不当,术后血肿压迫,神经阻滞麻醉过程针刺伤,止血带时间过长,术后加压包扎过紧,严重膝外翻屈曲畸形矫形。5例（83.3%）完全恢复,1例行神经探查手术,术后症状一度加重,随访术后6个月运动功能恢复,但目前仍残留感觉麻木。结论初次TKA术后腓总神经麻痹是多种因素造成的,预防是关键,围手术期应注意识别可能发生的一些危险因素并谨慎操作。保守治疗可获得满意效果,神经探查手术应慎重。

Peroneal nerve palsy after primary total knee arthroplasty: predisposing factors and treatment

Objective To analyse the predisposing factors and treatment of peroneal nerve palsy after primary total knee arthroplasty（TKA）.Methods Six patients with documented peroneal nerve palsy were identified in a retrospective review of 1257 consecutive primary TKAs performed at one institution from January 2002 to November 2009.Follow-up ranged from 14 months to 56 months.Results Peroneal nerve palsy may be due to retractor placement error,hematoma compression,needle injuries of the nerve following regional anesthesia,prolonged use of pneumatic tourniquets,constrictive dressing,correction of severe valgus deformity.Conservative treatment was employed for every patient and one received exploration and decompression surgery of peroneal nerve.Five patients（83.3%） achieved complete recovery and another showed a partial recovery.Conclusion The etiology of peroneal nerve palsy after primary TKA is likely to be multifactorial.Prevention is the key and relies on identifying risk factors and careful operation.In our study,the conser- vative treatment showed a good result,then the exploration and decompressionsion surgery may be not the best choice for improvement of neurologic function.