人工膝关节置换术后切口外侧皮肤感觉障碍转归的5年随访研究  

Five-year follow up of lateral skin flap dysesthesia after total knee arthroplasty

作　　者：杨立新[1] 吴旭[2] 孟昭宇[1] 杨艺[3] 王宏伟[1] 吴超[1] 孙铁铮[2] 

机构地区：[1]北京市大兴区红星医院骨科,北京100076 [2]北京大学人民医院关节病诊疗研究中心 [3]北京军区总医院神经外科

出　　处：《中国骨与关节损伤杂志》2016年第4期365-368,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的对人工全膝关节置换(TKA)术后5年患者切口外侧皮肤感觉障碍区域的转归进行随访,并分析相关因素及其对关节功能的影响。方法笔者自2008-10—2008-12对67例(100膝)晚期膝关节疾病行TKA术后1周切口外侧皮肤感觉障碍分布大小进行测量,术后5年进行随访,将术后1周与术后5年切口外侧皮肤感觉障碍区域大小进行对比,并行膝关节KSS、WOMAC、SF-36评分,进行相关性分析。结果共随访44例(67膝),术后5年随访中所有患者已无痛觉缺失区,25.4%(17/67)膝关节切口外侧感觉减退已完全恢复,74.6%(50/67)膝关节仍存在切口外侧痛觉减退区;痛觉减退区面积为0~42.6(10.63±11.80)cm^2,较术后1周时减少84.7%,差异有统计学意义(t=18.3,P<0.001)。术后5年有主观麻木感11膝,无主观麻木感56膝,两者术后5年的痛觉减退面积之间差异有统计学意义(t=7.18,P<0.001);主观麻木与客观麻木患者与KSS评分、WOMAC评分、BMI、是否髌骨置换等均无相关性。术后5年痛觉减退面积与切口长度、髌骨置换与否、BMI、手术侧别均无显著相关性。术后5年时膝关节KSS评分、WOMAC评分、SF-36评分与术后1周及术后5年的痛觉减退面积无相关性。结论 TKA术后切口外侧感觉障碍面积可随时间大部分或完全恢复,其最终转归对术后膝关节功能无明显影响。Objective To follow up the change of lateral skin flap dysesthesia in 5-yeat after total knee arthroplasty（TKA）,and to explore the related factors and its effects on the knee functions. Methods The area of lateral skin flap dysesthesia was measured for 67 cases（100 knees） who had total knee arthroplasty（TKA） surgeries because of late stage knee osteoarthritis（OA） or Rheumatoid arthritis（RA） 1 week after their surgeries from Oct. 2008 to Dec. 2008. The follow up was completed 5years after surgeries and the size of the area of lateral skin flap dysesthesia was compared 1 week after surgeries. The knee KSS, WOMAC, SF-36 scores were also recorded for correlation analysis. Results At 5-year follow up after TKA, 11 knees had objective numbness and 56 knees had no objective numbness, the average area of hypalgesia at 5-year follow up between them showed significant difference（t =7.18,P〈0.001）. 25.4%（17/67） knees showed a complete restoration to normal sense around the knees, but 74.6%（50/67）knees showed residual area of hypalgesia. The average area of hypalgesia at 5-year after TKA was（10.63±11.80）cm^2（range： 0-42.6 cm^2）, significantly decreased by 84.7% from that of 1 week after TKA（t =18.3, P〈0.001）. At the 5-year follow-up, the lateral hypalgesia area did not affect the range of motion, KSS clinical and function score or the SF-36 score. Conclusion All patients got lateral skin flap hypalgesia after TKA and improvement occurs with time.Lateral skin incision hypoalgesia has no significant effect on their long-term function.

关 键 词：全膝关节置换术 感觉减退 相关性分析 

分 类 号：R687.3[医药卫生—骨科学]