股内侧肌下入路全膝关节置换术初步观察研究

Clinical analysis of total knee arthroplasty by minimally invasive minisubvastus approach

[目的]探讨股内侧肌下入路小切口微创全膝关节置换术的优点、风险及手术要点。[方法]自2005年4月-2006年12月本院共行全膝关节置换术204例（344膝），其中传统切口（convention incision，CI）置换组146例（246膝），经股内侧肌下入路微创（minimally invasive，MIS）置换组58例（98膝），均采用Zimmer公司NEXGEN-LPS人工全膝关节，记录麻醉时间、手术时间、住院时间；比较患者术后第一次下地时间，不同时间阶段行走距离、膝关节主动活动度、手术前后HSS评分以及手术并发症情况。[结果]204例均获随访，时间4—7个月（平均5个月），微创组和对照组麻醉时间、切口长度、手术时间、住院时间、下地时间比较差异均有统计学意义（u检验，P〈0．05），微创组麻醉时间、手术时间均大于对照组，切口长度、住院时间、下地时间均小于对照组。术后24h、1周、1月行走距离两组之间存在显著性差异（u检验，P〈0．05），术后3个月行走距离两组之间无显著性差异（u检验，P〉0．05）。术后24h、1周、2周非负重主动活动度两组之间存在显著性差异（u检验，P〈0．05），术后1个月行走距离两组之间无显著性差异（u检验，P〉0．05）。HSS评分术后24h、1周、2周膝关节HSS评分两组之间存在显著性差异（u检验，P〈0．05），术后1月HSS评分两组之间无显著性差异（u检验，P〉0．05）。[结论]股内侧肌下入路小切口微创全膝关节置换术股四头肌损伤小，术后膝关节主动活动时间较早，膝关节功能恢复较快，术后远期步行距离、膝关节非负重主动活动度及HSS评分两者无明显差别。

[ Objective] To investigate the advantages, risks and kye points of minimally invasive total knee arthroplasty with subvastus approach. [ Method] From April 2005 to December 2006, 204 primary total knee arthroplasties were performed, among them 146 cases with convention incision （CI）, 58 cases with minimally invasive subvastus approach （MIS） . All knees were implanted with the same prosthesis （NEXGEN -LPS, Zimmer） . The anesthesia time, operation time, hospitalization time were recorded. The first walking time, walking distance, active knee range of motion, preoperative and postoperative HSS Score and the complications were compared. [ Result] Totally 204 cases were followed up and the mean follow - up time was 22 months （ range, 13 -36 months） . The difference of anesthesia time, length of incision, operation time, hospitalization time, walking time had significance between the CI and MIS groups （ u test, P 〈 0. 05 ） . The difference of walking distance 3 months after operation was of no significanct （ u test, P 〉 0. 05 ） . The difference of active range of motion in 24 hours, 1 week, 2 weeks postoperation had significance between the two groups （ u test, P 〈 0. 05 ） . The difference of walking distance had no significance between the two groups （ u test, P 〉 0. 05） . The difference of HSS score in 24 hours, 1 week, 2 weeks after operation had significance between the two groups （ u test, P 〈 0. 05 ） . The difference of HSS score in 1 month after operation had no significance （ u test, P 〉 0. 05 ） . [Conclusion] The minimally invasive total knee arthroplasty with subvastus approach reduces the quadriceps injury, offers early active knee motion and quickly recovery of knee function. However there is no significant difference in long - term walking distance, range of motion and HSS score.