Tibial Neuropathy after Revision Total Knee Prosthesis: A Case Report

膝關節再置換後導致脛神經病變：個案報告

10.6315/TJPMR.202106_49(1).0009

王竣平(Chun-Ping Wang)；吳威廷(Wei-Ting Wu)；謝霖芬(Lin-Fen Hsieh)

tibial neuropathy ； total knee arthroplasty ； nerve conduction study ； ultrasonography ； electromyography ； 脛神經病變（tibial neuropathy） ； 膝關節全人工置換（total knee arthroplasty） ； 神經傳導檢查（nerve conduction study） ； 超音波（ultrasonography） ； 肌電圖（electromyography）

台灣復健醫學雜誌

49卷1期（2021 / 06 / 01）

105 - 111

英文

We describe a 74-year-old woman with right knee osteoarthritis experiencing right tibial neuropathy because of complications of total knee arthroplasty revision. Weakness in the right toe flexors and paresthesia over the sole of the right foot were observed after operation. A nerve conduction study and electromyographic examination indicated right tibial neuropathy. Radiography indicated a prosthesis fragment in the right popliteal fossa, and its location was different before and after surgery. Prosthesis fragment dislodgement was also confirmed through ultrasonography, and the nearby tibial nerve may have been entrapped because of the dislocation process and surrounding tissue fibrosis. Ultrasonography confirmed the prosthesis fragment did not contact the right tibial nerve directly. After considering her medical condition, we chose conservative treatment including therapeutic exercise, electrical stimulation and ultrasound-guided 5% glucose tibial nerve hydrodissection, and the patient's symptoms much recovered 6 months later. The causes of tibial neuropathy in our case may be different from those reported previously. Ultrasonography played a valuable role in the examination and treatment of the injured nerve.

本篇報告一位曾患右膝退化性關節炎之74歲女性，因膝關節再置換手術後造成右側脛神經病變之併發症。病人在術後被發現右腳趾屈肌無力及腳底感覺異常，安排神經傳導及肌電圖檢查後發現右側脛神經病變。X光檢查發現在右側膕窩處的人工關節碎片位置與術前不同。安排超音波檢查後確認人工關節碎片移位，且旁邊的脛神經可能因碎片移位以及碎片附近組織纖維化而被夾擠。超音波檢查確定人工關節碎片並未直接接觸右側脛神經，因此我們選擇使用保守治療，包括運動治療、電刺激以及使用超音波導引下5%葡萄糖水脛神經解套術，病患之症狀於6個月後大幅改善。本篇報告中造成脛神經病變的原因與過去文獻報導不同。超音波影像在受傷神經之評估檢查以及決定治療扮演了重要的關鍵角色。

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