微创股肌下入路与微创内侧髌旁入路全膝关节置换术的临床对照研究

赵文勇¹ 张晓刚^2△ 骆文远³  张超³  王春亮¹

（1.甘肃中医药大学，甘肃  兰州，730000；2.甘肃中医药大学附属医院，甘肃  兰州，730000；

 3.甘肃省人民医院，甘肃  兰州，730000）

中图分类号：R274.39     文献标识码：A    文章编号：1674-7860（2015）36-0126-04    证型：IDGB

【摘  要】目的：比较应用微创股肌下入路与微创内侧髌旁入路进行全膝关节置换术的临床效果。方法：将60例全膝关节置换术患者（共60膝）随机分为两组。A组28例用微创内侧髌旁入路，B组32例用微创股肌下入路。比较两组手术时间、麻醉时间、支持带松解率、切口长度、术中出血、术后伤口引流量、术后1 d进行VAS评分、直腿抬高时间、起始行走时间等指标。结果：术后所有患者伤口均达到Ⅰ期愈合，并获得12个月的随访，B组麻醉时间和手术时间长于A组（P＜0.05）；而外侧支持带松解率明显低于A组（P＜0.05）；两者切口长度、术中出血、术后伤口引流量均未表现出统计学差异（P＞0.05）。两组的直腿抬高时间、起始行走时间和术后3 d膝关节被动活动度（ROM）均有统计学差异，且B组优于A组（P＜0.05）；B组术后1个月KSS功能评分、术后3个月KSS功能和临床评分亦优于MPM组（P＜0.05）；二者影像学资料比较无统计学意义（P＞0.05）。结论：微创股肌下入路相对于微创内侧髌旁入路切口小，不干扰伸膝装置，能保护髌股关节稳定性，术后初期功能恢复快，但其对医生手术技术要求高，手术时间较长，在临床选择上须综合考虑。

【关键词】全膝关节置换术；手术入路；比较

【Abstract】Objective: To compare theclinical effects of total knee arthroplasty via mini-subvastus approach andmini-medial parapatellar approach. Methods: 60 patients with total kneearthroplasty (total 60 knees) were randomly divided into two groups. 28 casesin group A had mini-medial parapatellar approach and 32 cases in group Bmini-subvastus approach. The indicators such as the operation time, anesthesiatime, hydrolysis rate of support pine, length of incision, intraoperative hemorrhage,postoperative wound drainage, VAS score one day after surgery, time of straightleg raising and time of start walking of two groups were compared. Results: Allincisions were primary healing and all patients were followed up for 12 months.The anesthesia time and operation time in group B were longer than that ingroup A (P<0.05). The lateralsupport of the B group was significantly lower than that of the A group (P<0.05). The incision length,intraoperative bleeding and postoperative wound drainage were not statisticallysignificant(P>0.05). There weresignificant differences in the two groups in time of straight leg raising, timeof starting walking and knee joint passive activity (ROM) 3 days after surgery,in which B group was better than A group (P<0.05).In B group, the function score of KSS after 1month, the function score and theclinical score of KSS after 3 months were also better than that of A group (P<0.05). There was no statisticalsignificance in imaging data (P>0.05).Conclusion: Compared with mini-medial parapatellar approach, mini-subvastusapproach had small incision and postoperative early functional recovery andcould protect the stability of patellofemoral joint without interfering withthe knee extension mechanism. However, it required high surgical techniques andlong operation time, which should be comprehensively considered in clinicalchoice.

【Keywords】Totalknee arthroplasty; Surgicalapproach; Comparison

doi:10.3969/j.issn.1674-7860.2015.36.058

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