髌旁内外侧入路用于外翻膝人工全膝关节置换术的比较

Comparing medial with lateral parepatellar approach in total knee arthroplasty of valgus knee

目的比较膝关节外翻畸形患者采用全膝关节置换术髌骨内外侧口的手术方法及术后效果。方法选用我院19个膝关节外翻畸形全膝关节置换手术的病例,A组10个膝关节采用髌骨内侧切口,术前活动度为92°(71～123°),股胫角平均为15.43°(13～39°),膝关节HSS平均评分为26分。B组9个膝关节采用髌骨外侧切口,术前膝关节活动度为90°(69～121°),胫股角平均为14.21°,膝关节HSS评分为29分。分别选用髌骨内外侧入路,都应用后稳定型假体,常规截骨加单纯外侧软组织松解方法。随访检查术后12个月后膝关节活动度,X线外翻角,及膝关节HSS评分,并用统计学分析两组在以上方面的差异。结果 A组患者平均外翻角为6.21°,膝关节活动度为106°膝关节HSS平均评分为95分,B组平均外翻角为6.15°,膝关节活动度为105°膝关节HSS平均评分为94分,两组统计学分析外翻角的改变,膝关节活动度及膝关节HSS评分。结论对于膝关节外翻患者,全膝关节置换髌骨内外侧入路皆能达到满意的效果,且两组无统计学差异。

Objective To compare medial parepaterllar approach with lateral in patients performed total knee arthroplasty（TKA） with valgus knee deformity.Methods 19 TKAs were performed by means of medial and lateral parepatellar approach standard osteotomy and only lateral soft tissue release with posterior stabilized implants.A group of 10 knees were used medial patellar incision,Group B nine knee patella lateral parepatellar approach.Clinical,radiographic evaluations including range of motion（ROM） and Hospital for Special Surgery（HSS） were performed at follow-up.And analysis the differences in the above two groups using statistics.Results The average valgus angle of Group A was reduced from 15.43° to 6.21° after replacement,range of motion（ROM） was improved from 84.20° to 116.34° and The average HSS scores increased from 26 to 95 postoperatively.The average valgus angle of Group B from 14.87° to 6.15°,ROM from 81.32° to 115.87° and the average HSS scores from 27 to 94.Conclusions The techniques of both medial and lateral parapatellar approach can achieve satisfactory results.