全膝关节置换:股内侧肌下与内侧髌旁入路的比较

Total knee arthroplasty: Comparison between quadriceps sparing approach and medial parapatellar approach

背景:目前国内全膝关节置换以内侧髌旁入路为主,创伤大、恢复慢,而经股内侧肌下入路更符合正常解剖,能完整保留伸膝装置,临床对于二者的相关比较研究极少。目的:对比经股内侧肌下入路与内侧髌旁入路行全膝关节置换的早期疗效。方法:2009年1月至2010年1月,55例(70膝)膝关节病变患者被随机分为股内侧肌下入路组26例(35膝)和内侧髌旁入路组29例(35膝),分别采用经股内侧肌下入路与内侧髌旁入路行全膝关节置换。比较2组患者切口长度、手术时间、置换后引流量、依托考昔片追加量、疼痛度、直腿抬高时间、起始下地时间、住院时间、膝关节活动度、膝关节功能评分、假体力线对位以及并发症情况。所有假体均选用Johnson&Johnson公司旋转平台的Sigma型假体。结果与结论:55例患者获得12-24个月随访,均未出现感染、下肢深静脉血栓、血管神经损伤、关节不稳、假体松动或移位等并发症。所有假体均获得正确的力线对位。股内侧肌下入路组患者置换手术时间大于内侧髌旁入路组(P=0.00),而切口长度、置换后引流量、依托考昔片追加量、目测类比疼痛评分、直腿抬高时间、起始下地时间、住院时间、置换后3d膝关节活动度及美国特种外科医院评分均优于内侧髌旁入路组(P<0.05)。置换后3个月膝关节活动度、膝关节功能评分2组差异无显著性意义。提示经股内侧肌下入路全膝关节置换早期疗效显著优于经内侧髌旁入路,而2种入路在假体力线对位方面无差异。

BACKGROUND： Now, domestic total knee arthroplasty surgeries mainly use medial parapateliar approach, with the disadvantages of large trauma and slower recovery. The quadriceps sparing approach is more accorded with normal anatomy, which can keep the knee extension system intact. The clinical comparison between quadriceps sparing approach and medial parapatellar approach is rare. OBJECTIVE： To compare the early effect of total knee arthroplasty through quadriceps sparing approach and medial parapatellar approach. METHODS： From January 2009 to January 2010, 55 patients （70 knees） were randomly divided into quadriceps sparing approach group （n=26, 35 knees） and medial parapatellar approach group （n=29, 35 knees）. Patients in two groups received total knee arthroplasty through quaddceps sparing approach and medial parapatellar approach respectively. The incision length, operative time, postoperative drainage volume, additional amount of etoricoxib tablets, pain degree, straight leg raising time, start walking time, hospitalization time, range of motion of knee joint, Hospital for Special Surgery Knee Score, radiographic alignment of all components and complications were compared between two groups. All the prostheses used in this study were the Sigma type prostheses provided by the rotation platform of Johnson＆Johnson Company.RESULTS AND CONCLUSION： All the patients were followed-up for 12-24 months without infections, deep vein thrombosis, neurovascular injury, prosthesis instability, prosthesis loosening or displacement. Position of all the prostheses was normal in patients. The operative time in the quadriceps sparing approach group was longer than that in the medial parapatellar approach group （P=-0.00）, while the incision length, postoperative drainage volume, additional amount of etoricoxib tablets, visual analog scale, straight leg raising time, start walking time, hospitalization time, range of motion of knee joint at 3 days after replacement and Hospital for Special Surgery Knee Score in the quadriceps sparing approach group were better than those in the medial parapatellar approach group （P 〈 0.05）. There were no significant differences in range of motion of knee joint at 3 days after replacement and Hospital for Special Surgery Knee Score between two groups. The early effect of total knee arthroplasty through quadriceps sparing approach is better than the medial parapatellar approach, and there is no significant difference in prosthesis alignment between two methods.