外侧闭合楔形高位胫骨截骨术中腓神经状态的运动诱发电位分析。

IF 1.5 4区 医学 Q3 ORTHOPEDICS
Tetsuro Ishimatsu, Akira Maeyama, Taiki Matsunaga, Takuaki Yamamoto
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引用次数: 0

摘要

简介:腓总神经(CPN)麻痹已被报道为外侧闭合楔形高位胫骨截骨术(CWHTO)的术中并发症。然而,各种术中医源性原因已被报道,CPN麻痹的具体原因尚未明确确定。本研究旨在阐明牵开器对CWHTO中CPN状态的影响。材料与方法:18例患者23膝行经颅运动诱发电位(MEP)分析。在四个时间点检测CPN完整性:术前作为对照(第一期);在腓骨上放置牵开器后进行腓骨中段截骨术(第二期);将牵开器放置于胫骨后端后拉胫骨前肌(第三期);手术后(第四期)。术后CPN损伤通过麻痹的存在和踝关节背屈强度的手动肌肉测试(MMT)来评估。结果:第一期CPN平均振幅(100%)与第二期92.6%(64 ~ 100%)无显著差异(p = 0.53);然而,幅度从第2期明显下降到第3期59.0%(范围,15- 100%)(p < 0.01),第4期显著提高到77.4%(范围,20- 100%)(p < 0.01)。20个膝关节(87.0%)第三期CPN振幅降低。所有18例患者术后MMT评分均为5级,无CPN瘫痪。结论:23个膝关节中有20个(87.0%)表现出胫骨后端牵开器对CPN振幅的显著降低。因此,在CWHTO中,后牵开器应小心地放置在腓总神经上。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Motor-evoked potential analysis of peroneal nerve status during lateral closed wedge high tibial osteotomy.

Introduction: Common peroneal nerve (CPN) palsy has been reported as an intraoperative complication during lateral closed wedge high tibial osteotomy (CWHTO). However, various intraoperative iatrogenic causes have been reported, the specific cause of CPN palsy has not been clearly established. The present study aimed to clarify the effects of retractors on CPN status in CWHTO.

Materials and methods: 23 knees of 18 patients underwent CWHTO with transcranial motor-evoked potential (MEP) analysis. The CPN integrity was tested at four time-points: preoperatively as a control (first period); just after retractor placement on the fibula for fibular osteotomy in the middle portion (second period); just after retractor placement on the posterior tibia to pull the tibialis anterior muscle (third period); and after the procedure (fourth period). Postoperative CPN damage was evaluated by the presence of paralysis and a manual muscle test (MMT) for strength of ankle dorsiflexion.

Results: There was no significant difference in the mean amplitude of the CPN between the first (100 %) and 92.6 % (range, 64-100 %) in the second periods (p = 0.53); however, the amplitude was significantly reduced from the second period to 59.0 % (range, 15-100 %) in the third period (p < 0.01), and then significantly improved to 77.4 % (range, 20-100 %) in the fourth period (p < 0.01). In 20 knees (87.0 %), the amplitude of the CPN in the third period was reduced. All 18 patients had postoperative MMT grade of 5 without paralysis of the CPN.

Conclusion: 20 of 23 knees (87.0 %) revealed a significant reduction of the CPN amplitude by the retractor on the posterior tibia. Therefore, the posterior retractor should be carefully placed on the common peroneal nerve in CWHTO.

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来源期刊
Journal of Orthopaedic Science
Journal of Orthopaedic Science 医学-整形外科
CiteScore
3.00
自引率
0.00%
发文量
290
审稿时长
90 days
期刊介绍: The Journal of Orthopaedic Science is the official peer-reviewed journal of the Japanese Orthopaedic Association. The journal publishes the latest researches and topical debates in all fields of clinical and experimental orthopaedics, including musculoskeletal medicine, sports medicine, locomotive syndrome, trauma, paediatrics, oncology and biomaterials, as well as basic researches.
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