全膝关节置换术髌骨旁内侧入路和股内侧肌下入路对比研究
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摘要
目的探讨研究全膝关节置换术不同手术入路方式对髌股关节并发症及髌骨内外倾运动的影响。方法将我院骨关节科于2011年1月至2013年2月收治的40例首次行全膝关节置换术的骨关节炎患者按照随机数字表法分为髌旁内侧入路(medial parapatellar approach,MPA)组和股内侧肌下入路(subvastus approach,SVA)组,每组各20例。MPA组采用髌旁内侧入路方式行全膝关节置换术,SVA组采用股内侧肌下入路行全膝关节置换术。对比两种手术入路方式对髌股关节并发症和髌骨内外倾运动的影响。结果 MPA组置换时间较SVA组显著减少,但前者切口长度和下床活动时间均远高于后者,差异具有统计学意义(P<0.05)。两组术中出血量和置换后引流量差异无统计学意义(P>0.05);两组术前、术后1年和术后2年KSS评分和髌骨倾斜角差异均无统计学意义(P>0.05),术后3个月时MPA组KSS评分和胫骨关节屈30°时髌骨倾斜角差异显著(P<0.05);MPA组并发症发生率为5%,SVA为0,差异无统计学意义(P>0.05)。结论股内侧肌下入路全膝关节置换术较髌旁内侧入路方式对患者的伤害性刺激小,前者术后短期膝关节功能和髌骨倾斜角明显优于后者,但中远期疗效和并发症情况差异无统计学意义。
Objective To explore and study the effect of different surgical approaches on patellar joint complications and the internal and external tilt movement of patella in total knee arthroplasty. Methods 40 cases of patients with osteoarthritis of the knee joint treated in our hospital from January 2011 to February 2013 were divided into MPA group and SVA group according to the random digital table method with 20 cases in each group. The MPA group was treated with medial parapatellar approach for total knee arthroplasty,and the SVA group was treated with subvastus approach for total knee arthroplasty. The effects of two kinds of surgical approaches on patellar joint complications and the internal and external tilt movement of patella were compared. Results The replacement time in the MPA group was significantly decreased compared with that in the SVA group,but the length of incision and activity time getting out of bed were much higher than those in the latter,and the differences were statistically significant( P < 0. 05). There were no obvious differences in bleeding volume,postoperative drainage volume between the two groups( P > 0. 05). There were no significant differences in KSS scores and patellar tilt angles between the two groups before and at 1 year and 2 years after operation( P > 0. 05),and the difference was significant in the KSS scores and patellar tilt angles at 30 degrees of flexion of the knee at 3 months after operation( P < 0. 05). The complications rate was5% in the MPA group,which was 0 in the SVA group,and the difference was not statistically significant( P > 0. 05). Conclusion The injury stimulation by subvastus approach for total knee arthroplasty is smaller than that by medial parapatellar approach,and the short-term knee joint function and patellar tilt angle of the former are significantly superior to those of the latter,but there are no significant differences in the long-term efficacy and complications.
Objective To explore and study the effect of different surgical approaches on patellar joint complications and the internal and external tilt movement of patella in total knee arthroplasty. Methods 40 cases of patients with osteoarthritis of the knee joint treated in our hospital from January 2011 to February 2013 were divided into MPA group and SVA group according to the random digital table method with 20 cases in each group. The MPA group was treated with medial parapatellar approach for total knee arthroplasty,and the SVA group was treated with subvastus approach for total knee arthroplasty. The effects of two kinds of surgical approaches on patellar joint complications and the internal and external tilt movement of patella were compared. Results The replacement time in the MPA group was significantly decreased compared with that in the SVA group,but the length of incision and activity time getting out of bed were much higher than those in the latter,and the differences were statistically significant( P < 0. 05). There were no obvious differences in bleeding volume,postoperative drainage volume between the two groups( P > 0. 05). There were no significant differences in KSS scores and patellar tilt angles between the two groups before and at 1 year and 2 years after operation( P > 0. 05),and the difference was significant in the KSS scores and patellar tilt angles at 30 degrees of flexion of the knee at 3 months after operation( P < 0. 05). The complications rate was5% in the MPA group,which was 0 in the SVA group,and the difference was not statistically significant( P > 0. 05). Conclusion The injury stimulation by subvastus approach for total knee arthroplasty is smaller than that by medial parapatellar approach,and the short-term knee joint function and patellar tilt angle of the former are significantly superior to those of the latter,but there are no significant differences in the long-term efficacy and complications.
引文
[1]张可,杨桂姣.CT观察膝骨关节炎患者股骨远端旋转解剖标志的研究[J].中国现代医生,2015,53(17):17-19.
[2]庞忠政.人工全膝关节置换术在严重骨关节炎治疗中的应用研究[J].中国现代医生,2015,53(7):32-34.
[3]王浩汀,周一新.髌旁内外侧入路在外翻膝人工全膝关节置换术中的应用研究[J].中国医师杂志,2015,17(2):298-300.
[4]中华医学会风湿病学分会.骨关节炎诊断及治疗指南[J].中华风湿病学杂志,2014,18(5):15-17.
[5]Martimbianco ALC,Calabrese FR,Iha LAN,et al.Reliability of the“American Knee Society Score”(AKSS)[J].Acta Ortopédica Brasileira,2012,20(1):34-38.
[6]Anthony V,Florschutz Brian S,Parsley Irving M,et al.Capturing orthopaedic surgical site infection data and assessing dental recommendations with respect to total joint arthroplasty.[J].The Journal of the American Academy of Orthopaedic Surgeons,2015,23(15):55-59.
[7]罗珉,包茂德,王跃平,等.人工全膝关节表面置换术治疗重度骨关节炎的临床分析[J].浙江创伤外科,2015,16(1):134-135;136.
[8]黄保华,高兴华,林宇进,等.全膝关节置换术股内侧肌间入路的安全区[J].解剖学杂志,2011,34(3):388-390.
[9]胡健,蒋垚.全膝关节置换术入路选择探讨[J].国际骨科学杂志,2010,31(2):95-96.
[10]任姜栋,张晓岗,曹力,等.重度膝关节外翻畸形全膝关节置换术[J].中华骨科杂志,2014,34(6):645-651.
[11]李锋,张克,田华,等.僵硬膝的人工全膝关节置换治疗[J].中国骨与关节损伤杂志,2010,25(6):499-501.
[12]覃健,侯之启,王新亮,等.股内侧肌下入路初次全膝关节置换的手术技巧和早期结果[J].中华创伤杂志,2013,29(1):57-60.
[13]周炜,蔡俊丰,袁锋,等.全膝关节置换术不同手术入路疗效比较[J].现代中西医结合杂志,2013,22(34):3823-3825.
[14]郭峰,刘晋平,李正南.经髌骨正中入路与内侧髌旁入路行人工膝关节表面置换术临床效果分析[J].中国综合临床,2012,28(11):1204-1207.
[15]Ahmad,Mirdamadi Solmaz,Dashtkar Mahboobeh,et al.Dabigatran versus enoxaparin in the prevention of venous thromboembolism after total knee arthroplasty:A randomized clinical trial.[J].ARYA atherosclerosis,2014,10(6):292-297.
[2]庞忠政.人工全膝关节置换术在严重骨关节炎治疗中的应用研究[J].中国现代医生,2015,53(7):32-34.
[3]王浩汀,周一新.髌旁内外侧入路在外翻膝人工全膝关节置换术中的应用研究[J].中国医师杂志,2015,17(2):298-300.
[4]中华医学会风湿病学分会.骨关节炎诊断及治疗指南[J].中华风湿病学杂志,2014,18(5):15-17.
[5]Martimbianco ALC,Calabrese FR,Iha LAN,et al.Reliability of the“American Knee Society Score”(AKSS)[J].Acta Ortopédica Brasileira,2012,20(1):34-38.
[6]Anthony V,Florschutz Brian S,Parsley Irving M,et al.Capturing orthopaedic surgical site infection data and assessing dental recommendations with respect to total joint arthroplasty.[J].The Journal of the American Academy of Orthopaedic Surgeons,2015,23(15):55-59.
[7]罗珉,包茂德,王跃平,等.人工全膝关节表面置换术治疗重度骨关节炎的临床分析[J].浙江创伤外科,2015,16(1):134-135;136.
[8]黄保华,高兴华,林宇进,等.全膝关节置换术股内侧肌间入路的安全区[J].解剖学杂志,2011,34(3):388-390.
[9]胡健,蒋垚.全膝关节置换术入路选择探讨[J].国际骨科学杂志,2010,31(2):95-96.
[10]任姜栋,张晓岗,曹力,等.重度膝关节外翻畸形全膝关节置换术[J].中华骨科杂志,2014,34(6):645-651.
[11]李锋,张克,田华,等.僵硬膝的人工全膝关节置换治疗[J].中国骨与关节损伤杂志,2010,25(6):499-501.
[12]覃健,侯之启,王新亮,等.股内侧肌下入路初次全膝关节置换的手术技巧和早期结果[J].中华创伤杂志,2013,29(1):57-60.
[13]周炜,蔡俊丰,袁锋,等.全膝关节置换术不同手术入路疗效比较[J].现代中西医结合杂志,2013,22(34):3823-3825.
[14]郭峰,刘晋平,李正南.经髌骨正中入路与内侧髌旁入路行人工膝关节表面置换术临床效果分析[J].中国综合临床,2012,28(11):1204-1207.
[15]Ahmad,Mirdamadi Solmaz,Dashtkar Mahboobeh,et al.Dabigatran versus enoxaparin in the prevention of venous thromboembolism after total knee arthroplasty:A randomized clinical trial.[J].ARYA atherosclerosis,2014,10(6):292-297.