髌旁外侧入路膝关节置换术矫正外翻膝畸形的研究进展

Research progress of knee arthroplasty via lateral approach of the patella for correction of valgus knee deformity

全膝关节置换术(TKA)主要通过髌旁内侧入路(MPA)和髌旁外侧入路(LPA)完成。MPA是经典的TKA手术入路,具有外翻髌骨容易,手术视野暴露好等优点;但MPA易造成外侧组织松解不彻底及软组织平衡困难,导致术后髌骨轨迹不良和对线不好,同时由于对已松弛的内侧组织进行了松解暴露,会加重内侧的松弛和不稳。LPA虽然存在内翻髌骨困难,可能发生髌腱止点处撕脱,术后切口关闭困难等缺点;但LPA能有效松解外侧组织,使处于半脱位或脱位的髌骨能很好复位,获得良好的髌骨轨迹,同时减少对髌骨血运的不良影响;此外LPA还能较方便地对髂胫束进行松解,矫正伸直位的外翻畸形。越来越多的学者认为LPA比MPA疗效更好,对于重度外翻膝的患者,LPA的优势会更加明显。本文就LPA在TKA中应用的研究进展作一综述。

The main approaches of total knee arthroplasty(TKA)are the medial approach of the patella(MPA)and the lateral approach of the patella(LPA).MPA is a classic TKA surgical approach,with the advantages of easy control of patellar eversion and adequate exposure.However,some disadvantages of MPA,such as incomplete correction of lateral tissue and difficult restoration of soft tissue,result in poor postoperative patellar trajectory and lower limb force line alignment.Relaxation and instability of the medial side may become aggravated by loosening the relaxed medial tissue.It is difficult to exert patellar eversion via LPA,and complications such as avulsion at the site of ablation and difficulty in closing the incision are frequently observed in the LPA.However,LPA can effectively release the lateral tissue,completely correct the patella in the subluxation or dislocation,achieve good varus and valgus stability and patella trajectory,and reduce the adverse effects of tibia blood transport.In addition,LPA can more easily release the tensional iliotibia tract and improve the valgus deformity of the extension position.More and more researchers believe that LPA is more effective than MPA for patients with severe valgus knees.This review summarizes the research progress of LPA application in TKA.