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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Incidence and Characterization of Injury to the Infrapatellar Branch of the Saphenous Nerve after ACL Reconstruction: A Prospective Study
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Incidence and Characterization of Injury to the Infrapatellar Branch of the Saphenous Nerve after ACL Reconstruction: A Prospective Study

机译：ACL重建后大隐神经pat下支损伤的发生率和特征：前瞻性研究

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Objectives: The infrapatellar branch of the saphenous nerve is commonly injured in anterior cruciate ligament reconstruction (ACLR) causing sensory deficits around the knee. The primary purpose of this prospective study was to determine the incidence of patient reported sensory deficits around the knee following ACLR. The secondary purpose was to determine if sensory deficits caused by intraoperative injury present at 6 weeks changed in severity and total area after 6 months and 1 year postoperatively. Methods: Two-hundred and fifty patients that underwent ACLR with or without meniscal repair were prospectively enrolled. Variables for each patient included: type of graft, direction of tibial incision, number of portals, and length of surgical incision. The grafts used were categorized into three types: Allograft (allo), hamstring autograft (HS), or patella tendon autograft (BTB). At 6 weeks, patients completed a questionnaire to ascertain any sensory deficits over their knee. Patients rated their sensory deficit on a scale from 0-10 (“0” = (no deficit) to “10” (complete lack of sensation) and shaded areas on a picture of a knee split into nine rectangular segments (3 by 3 grid) to determine the location of any numbness. Patients completed the same questionnaire at 6 months and 1 year. Any patient that was noted to have no stated numbness at 6 weeks or 6 months was noted to have completed the study. A mixed effects linear regression model was used to identify variables which were predictors for the patient-reported severity of numbness. Results: Overall, 67/221 (30.3%) patients who underwent ACLR stated that they had no numbness at 6 weeks. Of those patients who reported numbness at 6 weeks, 16.6% (25/151) considered their numbness completely resolved by six months. At 1 year, 73.2% (90/123) reported their numbness had gotten better and 14.2% (18/123) considered their numbness resolved. The most common location of numbness was along the inferolateral aspect of the knee. The mean numbness rating for allografts was 2.73 +/- 0.32 (mean +/- standard error) at 6 weeks, decreasing to 1.04 +/- 0.26 at 6 months and 0.64 +/- 0.26 at 1 year for oblique and vertical incisions combined. A statistical model, controlling for time and incision direction, indicated that HS patients were 1.94 +/- 0.52 points higher than allograft patients across all time points, and BTB patients were 1.57 +/- 0.51 points higher than allo. However, there were no significant difference in mean numbness score between BTB and HS patients (p=0.521). Time had a negative impact on the patient reported severity of numbness score for all graft types. At 6 months this effect was -0.95 +/- 0.17 and at 1 year, -1.21 +/- 0.18. The use of BTB increased the mean numbness of affected segments by 0.67 +/- 0.23, while the use of a HS increased the mean numbness of segments by 0.39 +/- 0.21. The mean number of segments decreased slightly with time, down by 0.20 +/- 0.08 at 6 months (p=0.008) and 0.28+- 0.08 at 1 year (p=<0.001). Conclusion: Sensory deficits after ACLR follow the direction of the infrapatellar branch of the saphenous nerve. Patients who underwent ACLR with allo were less likely to develop sensory deficits compared to BTB or HS. Sensory deficits in allo patients were on average, less severe. Surprisingly, there was no significant difference in numbness between HS and BTB grafts. Surgeons should counsel their patients that sensory deficits are common postoperatively after ACLR, but that this sensory disturbance is likely to dissipate with time.
机译：目的：在前交叉韧带重建术（ACLR）中，隐神经的pat下支通常会受伤，导致膝盖周围的感觉缺陷。这项前瞻性研究的主要目的是确定ACLR后患者报告的膝盖周围感觉障碍的发生率。次要目的是确定术后6个月和1年后第6周出现的因术中受伤引起的感觉缺陷是否在严重程度和总面积上发生改变。方法：前瞻性纳入250例接受或不接受半月板修复的ACLR患者。每个患者的变量包括：移植物类型，胫骨切口的方向，门的数量和手术切口的长度。所使用的移植物分为三种类型：同种异体移植物（allo），auto绳肌自体移植物（HS）或骨肌腱自体移植物（BTB）。在第6周，患者完成了一份问卷，以确定膝盖上的任何感觉缺陷。患者将他们的感觉缺陷评分为0-10（“ 0” =（无缺陷）至“ 10”（完全没有感觉）），并且在膝盖图像上的阴影区域分为九个矩形部分（3 x 3格） ）以确定任何麻木的位置。患者在6个月和1年时完成了相同的问卷调查。注意到在6周或6个月时没有出现麻木的任何患者都已完成研究。混合效应线性回归结果：总体上，接受ACLR治疗的67/221（30.3％）患者表示在6周时没有麻木。 6周内，有16.6％（25/151）的人认为他们的麻木在六个月内完全解决了;在1年时，有73.2％（90/123）的人的麻木得到了改善，有14.2％（18/123）的人的麻木已解决。麻木最常见的位置是在下外侧膝盖同种异体移植的平均麻木评分在第6周时为2.73 +/- 0.32（平均+/-标准误差），在第6个月时降低为1.04 +/- 0.26，在合并斜向和垂直切口的第1年时降至0.64 +/- 0.26。控制时间和切口方向的统计模型表明，在所有时间点，HS患者比同种异体移植患者高1.94 +/- 0.52点，而BTB患者比同种异体移植高1.57 +/- 0.51点。但是，BTB和HS患者之间的平均麻木评分没有显着差异（p = 0.521）。时间对患者报告的所有移植物类型的麻木评分严重程度均具有负面影响。在6个月时，此影响为-0.95 +/- 0.17，在1年时为-1.21 +/- 0.18。 BTB的使用使受影响节段的平均麻木增加了0.67 +/- 0.23，而HS的使用使节段的平均麻木增加了0.39 +/- 0.21。平均段数随时间略有下降，在6个月时下降0.20 +/- 0.08（p = 0.008），在1年时下降0.28 +/- 0.08（p = <0.001）。结论：ACLR后感觉障碍遵循隐神经nerve下分支的方向。与BTB或HS相比，接受同种异体ACLR的患者发生感觉缺陷的可能性较小。平均而言，同种异体患者的感觉缺陷较轻。令人惊讶的是，HS和BTB移植物之间的麻木感没有显着差异。外科医生应告知患者，ACLR术后常出现感觉缺陷，但这种感觉障碍可能会随着时间消散。

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