人工全膝关节置换后切口周围皮肤麻木:如何治疗?

摘要

BACKGROUND: Dermal hypoesthesia surrounding the incision usually occurs after total knee arthroplasty (TKA), which severely affects the patients' life quality. But the relevant studies are still immature, and its prevention methods and prognosis remain controversial.OBJECTIVE: To review the research and progress of dermal hypoesthesia following TKA.METHODS: A computer-based online research of CJFD, WanFang, VIP and Medline databases was performed for the literature addressing the dermal hypoesthesia surrounding the incision after TKA published from December 2001 to December 2016. The keywords were "total knee arthroplasty, incision, numbness, abnormal sensation" in English and Chinese, respectively. Finally, 36 eligible articles were selected for result analysis after excluding the repetitive ones.RESULTS AND CONCLUSION: (1) Dermal hypoesthesia surrounding the incision following TKA is commonly seen, but the related researches are few. Most of researches concentration on protecting against cutaneous nerve injury by modifying surgical approach, nerve conduit, neural nutrients and surgical repair, but all possess certain shortcomings, so there is a lack ideal prevention scheme. (2) The repairing methods for peripheral nerve injury, including biomolecular, cell and catheter therapies, have been applied in the repair of cutaneous nerve injury following TKA, but still on initial stage,and its effectiveness and safety need to be confirmed in depth. (3) Therefore, whether dermal hypoesthesia surrounding the incision following TKA needs treatment or not, and how to treat is an urgent problem for joint surgeon.%背景:人工全膝关节置换后患者切口周围皮肤麻木在临床上普遍存在,是影响患者术后生活质量的因素之一,其研究仍处于试验阶段,防治方法及预后转归也尚未达成共识.目的:将对人工膝关节置换后切口周围皮肤麻木的研究现状和防治进展做一综述.方法:计算机检索中国期刊全文数据库、万方数字化期刊全文数据库、维普中文科技期刊数据库及美国国立图书馆2001年12月至2016年12月发表有关人工全膝关节置换术后切口周围皮肤麻木的文献.以"全膝关节置换术"、"切口""麻木""感觉异常"为检索词,剔除重复性研究,最终选择具有代表性的36篇文献进行综述.结果与结论:①临床上全膝关节置换患者术后普遍存在切口周围皮肤麻木的现象,而这一问题目前国内外也较少有研究,主要集中在改良手术入路预防皮神经损伤、神经导管、神经营养药物、手术修复等方面,但仍存在诸多未知问题,目前也缺乏理想的的防治方案;②将周围神经损伤后的修复治疗应用于全膝关节置换后患者皮神经损伤的修复,包括生物分子治疗、细胞治疗以及导管治疗等,但其临床研究仍处于试验阶段,其安全性、有效性仍需进一步研究确定;③因此,关于全膝关节置换术后患者切口周围皮肤麻木是否需要治疗、如何治疗仍然是今后关节科医生亟待解决的问题.