{"title":"预防性腓神经减压在重度外翻畸形患者初次全膝关节置换术中的作用。","authors":"Asim Makhdom, Amber A Hamilton, S Robert Rozbruch","doi":"10.5005/jp-journals-10080-1545","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Common peroneal nerve (PN) palsy after total knee arthroplasty (TKA) is a serious complication. Although many authors suggest delayed or immediate PN decompression after TKA in these patients, little is known about the role of prophylactic peroneal nerve decompression (PPND) at the time of TKA. The aim is to report the results of PPND in high-risk patients at the time of TKA.</p><p><strong>Materials and methods: </strong>A multi-institutional retrospective study review of nine patients (10 knees) who underwent PPND at the time of TKA was conducted. Patients who had severe valgus deformities (≥15° of femorotibial angle and not fully correctable by examination under anaesthesia) with or without flexion contractures were included. PPND was performed through a separate 3-4-cm incision at the time of TKA. The demographics, preoperative and postoperative anatomical and mechanical alignments, range of motion, operation time, postoperative neurological function and complications were recorded.</p><p><strong>Results: </strong>All patients had a completely normal motor and sensory neurological function postoperatively and no complications related to PPND were reported. All patients followed the standard physical therapy protocol after TKA without modifications.The mean preoperative femorotibial angle was 20° (range 15-33°) and the mean postoperative femorotibial angle was 6.3° (range 5-9°) (<i>p</i> = 0.005). The mean preoperative flexion contracture was 9 (range 0-20) and the mean residual contracture was 1.2° (range 2-5°) (<i>p</i> = 0.006).</p><p><strong>Conclusion: </strong>PPND at the time of TKA is an option to minimise the risk of PN palsy in high-risk patients. This approach can be considered for patients undergoing TKA in selected high-risk patients with a severe valgus deformity.</p><p><strong>How to cite this article: </strong>Makhdom A, Hamilton AA, Rozbruch SR. The Role of Prophylactic Peroneal Nerve Decompression in Patients with Severe Valgus Deformity at the Time of Primary Total Knee Arthroplasty. Strategies Trauma Limb Reconstr 2022;17(1):38-43.</p>","PeriodicalId":1,"journal":{"name":"Accounts of Chemical Research","volume":null,"pages":null},"PeriodicalIF":16.4000,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d7/5b/stlr-17-38.PMC9166255.pdf","citationCount":"4","resultStr":"{\"title\":\"The Role of Prophylactic Peroneal Nerve Decompression in Patients with Severe Valgus Deformity at the Time of Primary Total Knee Arthroplasty.\",\"authors\":\"Asim Makhdom, Amber A Hamilton, S Robert Rozbruch\",\"doi\":\"10.5005/jp-journals-10080-1545\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Common peroneal nerve (PN) palsy after total knee arthroplasty (TKA) is a serious complication. Although many authors suggest delayed or immediate PN decompression after TKA in these patients, little is known about the role of prophylactic peroneal nerve decompression (PPND) at the time of TKA. The aim is to report the results of PPND in high-risk patients at the time of TKA.</p><p><strong>Materials and methods: </strong>A multi-institutional retrospective study review of nine patients (10 knees) who underwent PPND at the time of TKA was conducted. Patients who had severe valgus deformities (≥15° of femorotibial angle and not fully correctable by examination under anaesthesia) with or without flexion contractures were included. PPND was performed through a separate 3-4-cm incision at the time of TKA. The demographics, preoperative and postoperative anatomical and mechanical alignments, range of motion, operation time, postoperative neurological function and complications were recorded.</p><p><strong>Results: </strong>All patients had a completely normal motor and sensory neurological function postoperatively and no complications related to PPND were reported. All patients followed the standard physical therapy protocol after TKA without modifications.The mean preoperative femorotibial angle was 20° (range 15-33°) and the mean postoperative femorotibial angle was 6.3° (range 5-9°) (<i>p</i> = 0.005). The mean preoperative flexion contracture was 9 (range 0-20) and the mean residual contracture was 1.2° (range 2-5°) (<i>p</i> = 0.006).</p><p><strong>Conclusion: </strong>PPND at the time of TKA is an option to minimise the risk of PN palsy in high-risk patients. This approach can be considered for patients undergoing TKA in selected high-risk patients with a severe valgus deformity.</p><p><strong>How to cite this article: </strong>Makhdom A, Hamilton AA, Rozbruch SR. The Role of Prophylactic Peroneal Nerve Decompression in Patients with Severe Valgus Deformity at the Time of Primary Total Knee Arthroplasty. 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引用次数: 4
摘要
背景:全膝关节置换术(TKA)后腓总神经麻痹是一种严重的并发症。尽管许多作者建议这些患者在TKA后延迟或立即进行PN减压，但对于TKA时预防性腓神经减压(PPND)的作用知之甚少。目的是报告高危患者TKA时PPND的结果。材料和方法:对9例(10个膝关节)在TKA时接受PPND的患者进行了多机构回顾性研究。伴有或不伴有屈曲挛缩的严重外翻畸形(股胫角≥15°，麻醉检查不能完全矫正)患者纳入研究范围。在TKA时通过单独的3-4 cm切口进行PPND。记录患者的人口统计学、术前和术后解剖和机械对齐、运动范围、手术时间、术后神经功能和并发症。结果:所有患者术后运动和感觉神经功能完全正常，无PPND相关并发症。所有患者均遵循TKA后的标准物理治疗方案，无任何修改。术前平均股胫角为20°(15 ~ 33°)，术后平均股胫角为6.3°(5 ~ 9°)(p = 0.005)。平均术前屈曲挛缩为9(范围0-20)，平均残余挛缩为1.2°(范围2-5°)(p = 0.006)。结论:TKA时的PPND是将高危患者PN性麻痹风险降至最低的一种选择。对于有严重外翻畸形的高危患者，可以考虑采用这种方法进行全膝关节置换术。Makhdom A, Hamilton AA, Rozbruch SR.原发性全膝关节置换术时预防性腓神经减压在严重外翻畸形患者中的作用。创伤肢体重建2022;17(1):38-43。
The Role of Prophylactic Peroneal Nerve Decompression in Patients with Severe Valgus Deformity at the Time of Primary Total Knee Arthroplasty.
Background: Common peroneal nerve (PN) palsy after total knee arthroplasty (TKA) is a serious complication. Although many authors suggest delayed or immediate PN decompression after TKA in these patients, little is known about the role of prophylactic peroneal nerve decompression (PPND) at the time of TKA. The aim is to report the results of PPND in high-risk patients at the time of TKA.
Materials and methods: A multi-institutional retrospective study review of nine patients (10 knees) who underwent PPND at the time of TKA was conducted. Patients who had severe valgus deformities (≥15° of femorotibial angle and not fully correctable by examination under anaesthesia) with or without flexion contractures were included. PPND was performed through a separate 3-4-cm incision at the time of TKA. The demographics, preoperative and postoperative anatomical and mechanical alignments, range of motion, operation time, postoperative neurological function and complications were recorded.
Results: All patients had a completely normal motor and sensory neurological function postoperatively and no complications related to PPND were reported. All patients followed the standard physical therapy protocol after TKA without modifications.The mean preoperative femorotibial angle was 20° (range 15-33°) and the mean postoperative femorotibial angle was 6.3° (range 5-9°) (p = 0.005). The mean preoperative flexion contracture was 9 (range 0-20) and the mean residual contracture was 1.2° (range 2-5°) (p = 0.006).
Conclusion: PPND at the time of TKA is an option to minimise the risk of PN palsy in high-risk patients. This approach can be considered for patients undergoing TKA in selected high-risk patients with a severe valgus deformity.
How to cite this article: Makhdom A, Hamilton AA, Rozbruch SR. The Role of Prophylactic Peroneal Nerve Decompression in Patients with Severe Valgus Deformity at the Time of Primary Total Knee Arthroplasty. Strategies Trauma Limb Reconstr 2022;17(1):38-43.
期刊介绍：
Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance.
Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.
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