膝关节置换术后皮肤麻痹的解剖基础及相关临床研究

doi:10.13418/j.issn.1001-165x.2016.02.001

Abstract

Abstract:

Objective　To explore the infrapatellar branch of the saphenous nerve (IPBSN) that is apt to be injured during total knee arthroplasty (TKA), leading to numbness in its area of distribution, and modify the incision of TKA to decrease numbness.　Methods　12 cadaveric knees were dissected, the origin of the nerve was traced in relation with the sartouius muscle and the knee anatomy mark, the course and terminal branches of the nerve were observed and recorded. Then a modified knee lateral incision for TKA was designed, and the results were collected and compared with the med-line incision group.　Results　The nerve was found to the emerge near the anterior border of sartorius muscle, with a distance to the medial margin of the patella being 3.2 cm. In a majority of the cases (75%), there were 3 branches between the apex of patella and tibial tuberosity; in the center of the patella tendon, a coordinate system was made, and the majority of the nerve fibers lied in the first quartile of the right knee, and in the second quartile of the left knee. 15 TKA cases were performed using the modified lateral incision. The surgery was uneventful, and the post-operation numbness rate and scope were significantly reduced than in the control group.　Conclusion　By enriching the knowledge of these variable anatomical position of the IPBSN, an modified lateral incision for TKA with reduced incidence of numbness is feasible and valuable.

Key words: Infrapatellar branch(IPBSN), Total knee arthroplasty(TKA), Numbness, Incision

GAO Xing-hua, LIU Yong-yi, WANG Min-cong, ZHANG Guang-ming, HOU Zi-qi. The anatomical study of infrapatellar branch of the saphenous nerve and design of a modified incision to decrease numbness following total knee arthroplasty[J]. Chinese Journal Of Clinical Anatomy, 2016, 34(2): 121-125.

References

[1] Borley NR, Edwards D, Villar RN. Lateral skin flap numbness after total knee arthroplasty[J]. J Arthroplasty, 1995, 10(1): 13-14.
[2] Hopton BP, Tommichan MC, Howell FR. Reducing lateral skin flap numbness after total knee arthroplasty[J]. Knee, 2004, 11(4): 289-291.
[3] Johnson DF, Love DT, Love BR, et al. Dermal hypoesthesia after total knee arthroplasty[J]. Am J Orthop, 2000, 29(11): 863-866.
[4] Sundaram RO, Ramakrishnan M, Harvey RA, et al. Comparison of scars and resulting hypoaesthesia between the medial parapatellar and midline skin incisions in total knee arthroplasty[J]. Knee, 2007, 14(5): 375-378.
[5] Black R,Green C,Sochart D. Postoperative numbness of the knee following total knee arthroplasty[J]. Ann R Coll Surg Engl, 2013, 95(8):565-568.
[6] Tennent TD, Birch NC, Holmes MJ, et al. Knee pain and the infrapatellar branch of the saphenous nerve[J]. J R Soc Med, 1998,91(11): 573-575.
[7] Kerver A,Leliveld MS,Hartog D,et al.The surgical anatomy of the infrapatellar branch of the saphenous nerve in relation to incisions for anteromedial knee surgery[J]. J Bone Joint Surg Am, 2013,95(23): 2119-2125.
[8] 余正红，蔡胥，赵卫东，等. 膝关节神经分布的解剖学研究及其临床意义[J]. 中国临床解剖学杂志, 2008, 26(1):11-16.
[9] Ebraheim NA, Mekhail AO.The infrapatellar branch of the saphenous nerve: an anatomic study[J]. J Orth Trauma, 1997, 11(3): 195-199.
[10]Kalthur SG, Sumalatha S, Nair N,et al. Anatomic study of infrapatellar branch of saphenous nerve in male cadavers[J]. Ir J Med Sci, 2015, 184(1): 201-206.
[11]Laffosse JM, Potapov A, Michel M, et al. Hypesthesia after Anterolateral versus Midline Skin Incision in TKA: A Randomized Study[J]. Clin Orthop Relat Res, 2011, 469: 3154-3163.
[12]Mǖller W. The Knee: Form, Function and Ligament Reconstruction[M].Heidelberg, Germany, Springer-Verlag, 1983.

[1]	Luo Ying, Dou Weiyu, Wu Xiaohang, Chen Jingkun, Peng Changgui, Pan Jianying . Risk factors of postoperative complications of calcaneal fractures treated with hippocampal plate internal fixation through minimally invasive method [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 83-88.
[2]	Chen Zhuhong, Li Yanbing, Huang Huajun, Lin Xijiang, Zeng Canjun. Anatomical study of posterior pelvic ring injury combined with contralateral anterior pelvic ring injury treated with modified pararectus abdominis incision [J]. Chinese Journal of Clinical Anatomy, 2023, 41(6): 633-639.
[3]	Chen Zhengjun, Nie Yu, Wei Yi, Zhou Fang, Ren Shangqing, Fan Shida, Lv Qian, Tian Jingzhi, Wang Dong. Modified single incision and multi-channel extraperitoneal robot-assisted laparoscopic radical prostatectomy (additional report of 120 cases) [J]. Chinese Journal of Clinical Anatomy, 2022, 40(6): 743-747.
[4]	Chen Liang, Hu Dingxiang, Duan Chao, Ma Chenxi , Deng Chuanfen, Liu Min. The treatment of intertrochanteric fractures with modified incision placement of proximal femur antirotational intramedullary nail [J]. Chinese Journal of Clinical Anatomy, 2022, 40(3): 333-337.
[5]	Hu Weixian, Wang Junjiang, Wu Deqing, Wu Wulin, Lv Zejian, Li Yong, Cai Guanfu, Yao Xueqing. Short-term efficacy and technical strategy of single-incision plus one assist port laparoscopic complete mesorectal excision (CME) of right colon cancer [J]. Chinese Journal of Clinical Anatomy, 2022, 40(2): 228-233.
[6]	Shen Guodong, Zou Yunxuan, Zhang Hongning, Yang Kangyong, Lai Zhibin, Zhu Yongzhan. Clinical efficacy of minimally Juvara combined with Akin osteotomy on severe hallux valgus [J]. Chinese Journal of Clinical Anatomy, 2022, 40(1): 89-92.
[7]	ZHANG Li-ren, LIU Jia-ming, LIU Zhi-li, ZHANG Zhi-hong. Measurement of anatomical parameters of cervical zero-incision interbody fusion cage [J]. Chinese Journal of Clinical Anatomy, 2019, 37(6): 627-632.
[8]	TU Yong-gang, REN Shao-dong, CHEN Ze-qun, MA Bang-xing, ZHANG Shi-fei, YUAN Hao-bin. Under-malleolus minimal incision, poking reduction and simple internal fixation in the treatment of compressive intra-articular fractures of calcaneus [J]. Chinese Journal of Clinical Anatomy, 2019, 37(3): 335-339.
[9]	ZHANG Xue-quan, LI Hui-jin, XIAO Zhi-qing, XIAO Xin-li, HUANG Chun-xu, ZHANG Huo-lin, ZENG Fen . Minimally invasive treatment of Sanders type Ⅲ calcaneal fractures with mini - plate and internal column screw [J]. Chinese Journal Of Clinical Anatomy, 2019, 37(2): 201-205.
[10]	ZHANG Ming-liang, JIN Gong-shen, WANG Gang, PAN Cheng-wu, ZHANG Song, QIAN Jun . Advantages of double ring areola incision in the application of multi-center benign breast tumor operation [J]. Chinese Journal Of Clinical Anatomy, 2017, 35(5): 579-583.
[11]	SONG Xiao-jun, WEI Xu-ming, NIU Yao-shen. Treatment of postoperative bulky flap with stripping and lipsuction technique [J]. Chinese Journal Of Clinical Anatomy, 2017, 35(4): 463-465.
[12]	. Single incision ORIF for the treatment of distal tibial and fibular fractures [J]. Chinese Journal Of Clinical Anatomy, 2016, 34(1): 108-110.
[13]	HUANG Bao-Hua, GAO Xing-Hua, LIN Yu-Jin, HOU Zhi-Qi. Anatomic features of patellar insertion of the vastus medialis and its significance for TKA through subvastus approach [J]. Chinese Journal Of Clinical Anatomy, 2011, 29(2): 159-161.
[14]	LI Liang, SUI　Liang, LV Guo-Qing, WU Ri-Zhao, LI 　Yue, LIU 　Zheng, BAI Zhi-Jun. The anatomical basis and therapeutic effects of repairing with musculocutaneous fiap for rectus abdominis in medium incisional hernia [J]. Chinese Journal Of Clinical Anatomy, 2011, 29(1): 109-111.
[15]	LIN Yu-Jin, GAO Xin-Hua, HUANG Bao-Hua, HOU Zhi-Qi. Anatomical features of infrapatellar fat pad vascular network and its significance in TKA [J]. Chinese Journal Of Clinical Anatomy, 2011, 29(1): 31-33.

The anatomical study of infrapatellar branch of the saphenous nerve and design of a modified incision to decrease numbness following total knee arthroplasty

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 15

Metrics

Comments

Recommended 0