全膝关节置换术后切口外侧皮肤感觉障碍的危险因素研究  

Risk factors of lateral skin sensory loss after total knee arthroplasty

作　　者：刘洪文 徐杰[2] 朱国涛 陈锦成 余博飞 LIU Hong-wen;XU Jie;ZHU Guo-tao;CHEN Jin-cheng;YU Bo-fei(Key Laboratory of Orthopedic Traumatology of Traditional Chinese Medicine and Rehabilitation of Ministry of Education,Fujian University of Traditional Chinese Medicine,Fuzhou 350001,China;Department of Orthopedics,Fujian Provincial Hospital,Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建中医药大学中医骨伤及运动康复教育部重点实验室,福州市350001 [2]福建医科大学省立临床医学院福建省立医院骨科,福州市350001

出　　处：《中国矫形外科杂志》2019年第21期1950-1953,共4页Orthopedic Journal of China

基　　金：福建省自然科学基金面上项目（编号：2019J01173）;福建省卫生厅中青年骨干人才项目（编号：2013-ZQN-ZD-1）

摘　　要：[目的]分析全膝关节置换术(TKA)后切口外侧皮肤感觉障碍的危险因素。[方法]前瞻性连续纳入本院拟行TKA手术的患者97例,观察术后是否发生切口外侧皮肤感觉障碍。比较患者的年龄、性别、膝别、BMI、糖尿病、高血压、手术时间、切口长度、近端切口缘距髌骨上缘的距离、远端切口缘距髌骨下缘的距离、畸形矫正度数、疼痛视觉模拟评分(VAS评分)、膝关节活动度、美国特种外科医院评分(HSS评分)、深静脉血栓、切口愈合等因素,采用多因素逻辑回归分析感觉障碍的危险因素。[结果] 97例患者中,70例出现术后切口外侧皮肤感觉障碍的,占72.16%,27例无外侧皮肤感觉障碍,占27.84%。两组单因素比较表明,感觉障碍组与感觉正常组在年龄、性别、膝别、BMI、糖尿病、高血压、手术时间、畸形矫正程度、VAS评分、膝关节活动度、HSS评分、深静脉血栓和切口愈合方面的差异均无统计学意义(P>0.05);但是,感觉障碍组的手术时间、切口长度、近端切口缘距髌骨上缘的距离、远端切口缘距髌骨下缘距离和畸形矫正度数均显著大于感觉正常组,两组间差异均有统计学意义(P<0.05)。多因素逻辑回归分析表明:切口长度(OR=5.213,P=0.002)、近端切口缘距髌骨上缘的距离(OR=6.953,P<0.001)、远端切口缘距髌骨下缘的距离(OR=7.981,P<0.001)是术后切口外侧皮肤感觉障碍的危险因素。[结论]切口长度、近端切口缘距髌骨上缘的距离和远端切口缘距髌骨下缘的距离是TKA术后切口外侧皮肤感觉障碍的独立危险因素。[Objective] To search the risk factors for skin sensory loss lateral to incision after total knee arthroplasty(TKA). [Methods] A prospective study was conducted on 97 consecutive patients who underwent TKA surgery in our hospital.Based on whether or not lateral skin sensory loss happed after TKA, the patients were divided into two groups. The age, gender,side involved, BMI, diabetes, hypertension, operation time, incision length, distance from proximal incision edge to upper patellar margin, distance from distal incision edge to lower patellar margin, deformity correction extent, VAS score, knee range of motion, HSS score, deep venous thrombosis, wound healing were compared univariately between the two groups. In addition, the multiple binary logistic regression was done to search the risk factors for sensory loss. [Results] Of the 97 patients, 70 patients got sensory loss accounted for 72.16%, while the remaining 27 patients had normal skin sensation accounted for 27.84% after TKA procedures. Compared the patients with or without sensory loss after TKA, there were no statistically significant differences regarding age, gender, knee affected, BMI, diabetes, hypertension, operation time, extent of deformity correction,VAS score, knee range of motion, HSS score, deep venous thrombosis and wound healing between them(P>0.05). The patients with sensory loss proved significantly greater than those without sensory loss in operation time, incision length,distance from proximal incision edge to upper patellar margin, distance from distal incision edge to lower patellar margin and extent of deformity correction(P<0.05). As results of the logistic regression analysis, the incision length(OR=5.213, P=0.002), distance from proximal incision edge to upper patellar margin(OR=6.953, P=0.001), distance from distal incision edge to lower patellar margin(OR= 7.981, P<0.001) was the risk factors of skin sensory loss. [Conclusion] The independent risk factors for skin sensory loss in the lateral incision after TKA include incision le

关 键 词：全膝关节置换术 皮肤切口 感觉障碍 危险因素 股内侧肌下入路 

分 类 号：R687.4[医药卫生—骨科学]