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目的探讨膝关节置换术后隐神经髌下支损伤所致的皮肤麻痹的解剖基础,改良手术切口,减少膝前皮肤麻木并发症。方法解剖观察12例成人尸体下肢标本,观测隐神经髌下支形态、神经束的走行及毗邻关系。设计改良膝外侧皮肤切口行膝关节置换手术入路进行临床验证,比较术后效果。结果解剖研究发现隐神经髌下支自缝匠肌穿出后,标本在髌骨中心平面神经距髌骨内侧缘约3.2 cm,75%标本有3束分支分布于髌骨下极及胫骨粗隆区域,以髌骨下极与粗隆连线中点为中心作圆,神经纤维主要分布左侧在第2象限,右侧在第1象限。临床研究采用改良膝关节外侧切口行膝关节置换术15例,方法可行,术后膝前皮肤麻木的发生率及范围较对照组减少,有统计学意义。结论根据膝关节隐神经髌下支解剖分布特点,改良膝前皮肤切口行膝关节置换术可减少术后膝前麻木。
Objective To investigate the anatomic basis of paralysis of the skin caused by injury of the saphenous nerve of the saphenous nerve after knee arthroplasty, to improve the surgical incision and reduce the complications of pre-knees skin numbness. Methods Anatomy of 12 adult cadaveric lower extremity specimens was observed. The morphology of saphenous nerve, the movement of the nerve bundle and its adjacent relationship were observed. Design improved knee lateral skin incision knee replacement surgery clinical validation, comparison of postoperative effects. Results Anatomical study found that the saphenous nerve of the inferior patellar branch since the sartorial piercing, the patellar plane central nerve in the medial patellar margin of about 3.2 cm, 75% of the three branches of the distribution in the patella and tibial tuberosity region to The lower pole of the patella is connected with the midpoint of the trochanter. The main distribution of the nerve fibers is in the second quadrant and the right quadrant in the first quadrant. Clinical study using modified lateral knee incision knee arthroplasty in 15 cases, the method is feasible, the incidence and extent of anterior knee skin numbness than the control group, with statistical significance. Conclusions According to anatomic distribution of saphenous nerve in the knee, the knee anterior knee incision can be reduced by modified knee anterior knee incision.