经股内侧肌下入路与髌旁入路对初次全膝关节置换术后膝关节早期功能锻炼的影响

Influence of subvastus and parapatellar approaches on early functional exercise of knee joint after primary total knee arthroplasty

目的观察经股内侧肌下入路与髌旁入路对初次全膝关节置换术后膝关节早期功能锻炼的影响。方法回顾性分析自2018-01—2018-12采用经股内侧肌下入路和内侧髌旁入路行全膝关节置换术治疗的45例膝关节骨性关节炎,根据手术入路不同分为经股内侧肌下入路组与内侧髌旁入路组,比较两组手术时间、切口长度、术中出血量、术后初次行直腿抬高动作及屈曲至90°的时间,以及术后疼痛VAS评分、膝关节HSS功能评分。结果所有患者均获得随访,随访时间至少3年。经股内侧肌下入路组手术时间比内侧髌旁入路长,但切口长度比内侧髌旁入路组短,两组术中出血量无明显差异。经股内侧肌下入路组术后首次行直腿抬高及屈曲90°均较内侧髌旁入路组早(P<0.05)。两组均无血管神经损伤、感染及下肢深静脉血栓形成。经股内侧肌下入路组术后第1天疼痛VAS评分低于内侧髌旁入路组(P<0.05),但是两组术后1、3个月疼痛VAS评分差异无统计学意义(P>0.05)。经股内侧肌下入路组术后1个月膝关节HSS功能评分高于内侧髌旁入路组(P<0.05),但是两组术后3个月、3年膝关节HSS功能评分差异无统计学意义(P>0.05)。结论与标准髌旁入路相比,经股内侧肌下入路行初次全膝关节置换术有利于缓解术后早期疼痛,患者能够更早行直腿抬高等功能锻炼,更符合加速康复外科理念。

Objective To observe the influence of the subvastus and parapatellar approaches on the early functional exercise of knee joint after primary total knee arthroplasty.Methods Forty-five cases of primary artificial knee arthroplasty were retrospectively selected and divided into subvastus approach group and parapatellar approach group from January 2018 to December2018.Operative time,incision length,intraoperative blood loss and the time after the first straight leg elevation and flexion to 90were recorded.The visual analogue Scale(VAS)score and Hospital for Special Surgery(HSS)score was compared after surgery.Results All patients were followed up for at least 3 years.The operation time of subvastus approach was longer than that of parapatellar approach.The length of the incision was shorter in subvastus approach than in parapatellar approach.There was no significant difference in intraoperative bleeding between the two groups.Postoperatively,the time to first straight leg raise and flexion to 90°was significantly earlier with subvastus approach than with traditional parapatellar approach(P<0.05).There were no vascular nerve injury,infection and deep venous thrombosis in both groups.On the 1st day after surgery,pain VAS score of the subvastus approach was significantly better than that of parapatellar approach(P<0.05).However,there was no significant difference in pain VAS scores 1 and 3 months after surgery between the two groups(P>0.05).HSS score through subvastus approach was better than that through parapatellar approach at 1 month after operation(P<0.05).There was no significant difference in HSS function scores between the two groups at 3 months and 3 years after surgery(P>0.05).Conclusion Compared with the parapatellar approach,the primary TKA through the subvastus approach is beneficial to relieve the early postoperative pain,and the patient can perform functional exercises such as straight leg raise earlier,which is more in line with the concept of ERAS.