슬관절 전치환술 후의 신경학적 합병증
Neurological Complication Following Total Knee Arthroplasty
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 슬관절 전치환술 후 발생한 신경학적 합병증을 조사하여 후향적으로 평가하였다. 대상 및 방법: 1983년부터 2002년까지 슬관절 전치환술을 시행받은 환자 1363명 1582예 중 신경학적 합병증을 보인 환자 중 5년 이상의 추시가 가능했던 148명 162예를 대상으로 하였다. 결과: 비골신경 마비 환자는 8명 9예였고, 이 중 5명 6예는 술 후 부목고정에 따른 비골두 부위 압박에 따른 마비였다. 1예는 비골부 구획증후군의 후유증으로 인한 경우였고, 2예는 원인을 알 수 없었고 2년 내 7예에서 회복하였다. 복재신경의 슬개하 분지 손상에 따른 감각이상은 153예였으며, 감각이상 부위는 3년 뒤 76예에서 50% 이상, 5년 뒤 105예에서 70% 이상 감소하였고 8예에서는 완전회복되었다. 결론: 비골신경 마비의 원인은 다인성 인자로 사료되며 2년 내에 대부분 회복하였고 복재신경의 슬개하 분지의 손상은 추시 결과 만족도에 영향을 미치지 않았다.
Abstract
Purpose: This study retrospectively evaluated the nerve injuries that occurred after total knee arthroplasty. Materials and Methods: Among 1,582 cases of total knee arthroplasty in 1,362 patients who underwent total knee arthroplasty from 1982 to 2002, 162 cases of neurologic complications in 148 patients who were followed up for over five years, and these case were examined in this study. Results: Among the 9 cases of peroneal nerve palsy in 8 patients, 6 cases of 5 patients were caused by compression of the peroneal nerve after applying a cylinder splint. One case was caused by damage of the peroneal nerve and soft tissue contracture due to peroneal compartment syndrome and two cases failed to reveal the cause of the peroneal nerve palsy. Seven cases recovered within 2 years. Among the 153 cases with sensory change that was caused by injury of the infrapatellar branch of the saphenous nerve, 76 cases recovered to 50% or more within three years postoperatively, and 105 cases recovered to 70% or more within 5 years postoperatively. Eight cases fully recovered. Conclusion: The causes of peroneal nerve palsy were considered to be multifactorial and almost all the cases recovered within 2 years. The injury of the infrapatellar branch of the saphenous nerve does not affect the results and the patients' satisfaction.
참고문헌 (21)
- Asp JP, "Peroneal nerve palsy after total knee arthroplasty", Clin Orthop Relat Res, 261, pp.233~237 (1990)
- Canale T, "Campbell’s operative orthopaedics. 11th ed", pp.241~299 (2008), Mosby
- Cho WS, "Knee joint arthroplasty. 2nd ed", pp.155~235 (2007), Young Chang
- Dowd GS, "Complex regional pain syndrome with special emphasis on the knee", J Bone Joint Surg Br, 89, pp.285~290 (2007)
- Ebraheim NA, "The infrapatellar branch of the saphenous nerve: an anatomic study", J Orthop Trauma, 11, pp.195~199 (1997)
- Horlocker TT, "Does postoperative epidural analgesia increase the risk of peroneal nerve palsy after total knee arthroplasty?", Anesth Analg, 79, pp.495~500 (1994)
- Hui FC, "Hinged total knee arthroplasty", J Bone Joint Surg Am, 62, pp.513~519 (1980)
- Idusuyi OB, "Peroneal nerve palsy after total knee arthroplasty. Assessment of predisposing and prognostic factors", J Bone Joint Surg Am, 78, pp.177~184 (1996)
- Kachar SM, "Neuroma of the infrapatellar branch of the saphenous nerve a cause of reversible knee stiffness after total knee arthr", J Arthroplasty, 23, pp.927~930 (2008)
- Kartus J, "The localization of the infrapatellar nerves in the anterior knee region with special emphasis on central third patellar tendon harvest: a dissection study on cadaver and amputated specimens", Arthroscopy, 15, pp.577~586 (1999)
- Kaushal SP, "Complications following total knee replacement", Clin Orthop Relat Res, 121, pp.181~187 (1976)
- Kim YH, "Peroneal nerve palsy after total knee arthroplasty", J Korean Knee Soc, 14, pp.131~136 (2002)
- Masakado Y, "Clinical neurophysiology in the diagnosis of peroneal nerve palsy", Keio J Med, 57, pp.84~89 (2008)
- Marshall JL, "Knee ligament injuries: a standardized evaluation method", Clin Orthop Relat Res, 123, pp.115~129 (1977)
- Mistry D, "of the infrapatellar branch of the saphenous nerve post total knee arthroplasty", ANZ J Surg, 5, pp.822~824 (2005)
- Nercessian OA, "Peroneal nerve palsy after total knee arthroplasty", J Arthroplsty, 20, pp.1068~1073 (2005)
- Rose HA, "Peroneal nerve palsy following total knee arthroplasty. A review of the hospital for special surgery experience", J Bone Joint Surg Am, 64, pp.347~351 (1982)
- Schinsky MF, "Nerve injury after primary total knee arthroplasty", J Arthroplasty, 16, pp.1048~1054 (2001)
- Tennent TD, "Knee pain and the infrapatellar branch of the saphenous nerve", J R Soc Med, 91, pp.573~575 (1998)
- Upton AR, "The double crush in nerve entrapment syndromes", Lancet, 2, pp.359~362 (1973)
- Webster DA, "Complications of variable axis total knee arthroplasty", Clin Orthop Relat Res, 193, pp.160~167 (1985)