股内侧肌下入路与髌旁内侧入路在老年膝关节置换中应用的初步临床分析

Preliminary clinical analysis of subvastus approach and medical parapatellar approach in knee arthroplasty in elderly patients

目的分析比较全膝关节置换术(total knee arthroplasty,TKA)中采用股内侧肌下入路(subvastus approach,SVA)与髌旁内侧入路(medial parapatellar approach,MPA)的早期临床疗效。方法回顾性分析2015年1月至2016年8月在本院完成初次TKA的69例病人资料(年龄均超过60岁),根据手术入路的不同分为SVA组和MPA组,记录并比较两组病人的手术切口长度、手术时间、总出血量、术后可直腿抬高时间、膝关节术后活动度(range of motion,ROM)。采用疼痛视觉模拟量表(visual analogue scale,VAS)评价病人疼痛情况,采用美国膝关节协会评分(knee society score,KSS)评价病人的膝关节功能。结果 SVA组病人的手术切口长度为(11.48±1.35)cm,与MPA组的(15.24±1.41)cm相比,差异有统计学意义(t=11.041,P<0.001);两组间手术总失血量及手术时间比较,差异均无统计学意义(t=0.209,P=0.835;t=1.003,P=0.320);SVA组病人的术后直腿抬高时间为(1.52±0.62)d,MPA组为(2.61±0.97)d,两组比较,差异有统计学意义(t=5.462,P<0.001)。术后第3、7天SVA组静息和活动状态下的VAS评分均优于MPA组,两组间比较,除外术后第7天静息状态下的VAS评分,其他时间及状态下的VAS评分差异均有统计学意义(P均<0.05)。术后第3、7天,MPA组病人的膝关节ROM(89.09°±5.51°、93.03°±7.06°)均小于SVA组(96.36°±4.55°、96.36°±6.53°),差异均有统计学意义(t=5.842,P<0.001;t=1.991,P=0.049)。术后2周,MPA组病人的KSS评分为(72.42±4.35)分,小于SVA组病人的(78.79±3.96)分,差异有统计学意义(t=6.214,P<0.001)。术后第1、3、6、9个月,两组间KSS评分和膝关节ROM比较,差异均无统计学意义(P均>0.05)。结论人工全膝关节置换采用SVA对伸膝装置影响小,可促进置换后关节功能及关节活动度的快速恢复,减少疼痛,提高术后满意度。

Objective To analyze and compare the early clinical effects of subvastus approach(SVA) vs. medial parapatellar approach(MPA) in total knee arthroplasty(TKA).Methods A retrospective analysis was made on 69 patients(all over 60 years old) who underwent the initial TKA in our hospital from January 2015 to August 2016. They were divided into two groups according to the different surgical approaches: SVA group and MPA group. The length of incision, operation time, total blood loss, time of straight leg elevation and range of motion(ROM) of knee joint were recorded and observed. Pain was assessed by visual analogue scale(VAS). And Knee Society score(KSS) was used to evaluate knee function.Results The incision length in SVA group was(11.48±1.35) cm, which was significantly shorter than that in MPA group[(15.24±1.41) cm](t=11.041, P<0.001). There was no significant difference in total blood loss and operation time between the two groups(t=0.209, P=0.835;t=1.003, P=0.320). The straight leg elevation time in MPA group was(2.61±0.97) days after operation, and that in SVA group was(1.52±0.62) days. There was significant difference(t=5.462, P<0.001). The VAS scores in resting and active state in SVA group were lower than those in MPA group at 3rd and 7th day after operation. There was no significant difference in VAS scores between the two groups in resting state at 7th day after operation(t=1.683, P=0.097), but there were significant differences at other time points and in other states(all P<0.05). At 3rd and 7th day after operation, ROM of knee joint in MPA group(89.09°±5.51° and 93.03°±7.06°) was significantly less than that in SVA group(96.36°±4.55° and 96.36°±6.52°)(t=5.842, P<0.001;t=1.991, P=0.049). At 2nd week after operation, the KSS score in MPA group was(72.42±4.35), which was significantly lower than that in SVA group(78.79±3.96)(t=6.214, P<0.001). At 1st, 3rd, 6th and 9th month after operation, there was no significant difference in KSS score and knee ROM between the two groups(all P>0.05).Conclusion The use of SVA in TKA has little effect on knee extensor. It can promote the rapid recovery of joint function and ROM after TKA, alleviate pain and improve postoperative satisfaction.