改良股肌下入路微创人工全膝关节置换术治疗中重度膝关节骨关节炎的效果

Effect of Minimally Invasive Surgery Total Knee Arthroplasty with Modified Subfemoral Approach in the Treatment of Moderate to Severe Knee Osteoarthritis

目的分析改良股肌下入路微创人工全膝关节置换术(MISTKA)治疗中重度膝关节骨关节炎患者的效果。方法选取2019年1月至2020年5月新野县人民医院收治的84例中重度膝关节骨关节炎患者,根据MISTKA手术入路分为两组,将经髌旁入路治疗的42例患者纳入对照组,将经股肌下入路治疗的42例患者纳入观察组。比较两组手术相关指标(切口大小、手术时间、术中失血量、术后引流量),术后恢复情况(镇痛药物辅助使用率、外侧支持带松解率、股四头肌肌力恢复时间),术前、术后1 d、1个月视觉模拟评分量表(VAS)评分以及术前、术后7 d、1、6个月膝关节被动活动度、膝关节骨性关节炎严重性指数(ISOA)评分。结果与对照组对比,观察组切口较小,术后引流量较少(P<0.05),两组手术时间、术中失血量比较,差异无统计学意义(P>0.05);观察组镇痛药物辅助使用率、外侧支持带松解率较对照组低,股四头肌肌力恢复时间较对照组短(P<0.05);术后1 d、1个月,两组疼痛程度均有所缓解,且观察组VAS评分较对照组低(P<0.05);术后7 d、1、6个月,两组膝关节被动活动度、膝关节功能均得到提升,且观察组膝关节被动活动度较对照组大,ISOA评分较对照组低(P<0.05)。结论改良股肌下入路MISTKA治疗中重度膝关节骨关节炎,能减轻创伤,减少术后引流量,减轻疼痛程度,促进患者恢复,提高膝关节功能。

Objective To analyze the effect of minimally invasive surgery total knee arthroplasty(MISTKA)with modified subfemoral approach in the treatment of moderate to severe knee osteoarthritis.Methods Eighty-four patients with moderate to severe knee osteoarthritis admitted from Xinye People’s Hospital from January 2019 to May 2020 were selected.They were divided into two groups according to MISTKA surgical entry,and 42 patients treated by the parapatellar approach were included in control group,and 42 patients treated by the subfemoral approach were included in observation group.Surgage-related indicators(incision size,duration of operation,intraoperative blood loss,postoperative drainage volume),postoperative recovery(auxiliary use rate of analgesic agents,release rate of lateral retinacular zone and recovery time of quadriceps muscle strength),visual analog scale(VAS)scores before surgery,1 day after surgery and 1 month after surgery,passive activity of knee joint,knee osteoarthritis severity index(ISOA)scores before surgery,7 days after surgery,1 month after surgery and 6 months after surgery were compared between the two groups.Results Compared with control group,observation group had smaller incision and less drainage volume(P<0.05),but there were no statistical differences between the two groups in operative duration and intraoperative blood loss(P>0.05).Compared with control group,the auxiliary use rate of analgesic agents and release rate of lateral retinacular zone were lower in observation group,and the recovery time of quadriceps femoris muscle strength was shorter(P<0.05).At 1 day and 1 month after surgery,the pain was relieved in the two groups,and the VAS score in observation group was lower than that in control group(P<0.05).At 7 days,1 month and 6 months after surgery,the knee joint passive activity degree and knee joint function were improved in the two groups,and observation group had higher knee joint passive activity degree and lower ISOA score(P<0.05).Conclusion The treatment of moderate and severe knee osteoarthritis by MISTKA with modified subfemoral approach can reduce the trauma,reduce the postoperative drainage volume and degree of pain,promote the recovery of patients and improve the function of knee joint.