全膝置换不同手术切口对早期伸膝功能恢复的比较  

Comparing the function of raising and extending knee after total knee arthroplasty with different surgical approach

作　　者：钱齐荣[1] 吴海山[1] 李晓华[1] 吴宇黎[1] 赵辉[1] 陶坤[1] 孙磊[1] 

机构地区：[1]上海市长征医院骨科,200003

出　　处：《中华关节外科杂志（电子版）》2007年第4期207-210,共4页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的探讨不同切口行全膝关节置换术后对早期伸膝功能康复情况的影响。方法本组共收治全膝关节置换术患者276例,413个膝关节置换术,男39例,女237例,年龄42～83岁,平均63.3岁。其中分组施行标准髌骨旁切口、股内侧肌中间切口、股肌下小切口置换膝关节。术后部分采取积极康复训练,观察术后患侧伸膝抬高的时间。结果显示小切口组与其他切口组均差异较大,功能有显著改善,但手术时间、止血带时间显著延长,出血量大大增加。积极鼓励和劝告组则与所有各组均有较大差异。结论本研究提示止血带时间、疼痛可能并非股四头肌手术后功能受损的主要原因。手术切口创伤对股四头肌功能是有一定的影响,但是积极鼓励和劝告的则具有多方面的优势。但是尚需进一步的研究来验证。Objective The purpose of the present study was to determine the role of surgery approach and the rehabilitation in the early recovery of quadriceps strength after total knee arthroplasty. Methods Two hundred seventy six patients with four hundred thirteen knees had accepted total knee arthroplasty. There were 39 male and 237 female, 42 - 83 years old, and average age was 63.3 years old. The surgical approach was standard para-patellar approach （SP）, mid-vastus approach （MV） and mini-sub-vastus approach （MIS） . Some of the patients received actively rehabilitation. The most important index is the time of the patient actively raising and extending the knee up away the bed. Results The result showed that there was significant difference between the MIS group and the SP or MV groups. The active rehabilitation group had great significant difference with other groups. The MIS group has great difference between these two groups with much longer surgical and tourniquet time and more blood losing. Conclusions This research suggests that tourniquets using and pain may not be the major cause of the quadriceps muscle weakness post surgery. Different surgical approach had certain effect on the impairing or protecting of the quadriceps muscle, but rehabilitation had greater effect than surgical injury on the function recovery of the quadriceps muscle. Suggestion psychology has shown effect on improving voluntary muscles activation in this study. But it need further research to be proved.

关 键 词：关节成形术 置换 膝 切口 康复 镇痛 

分 类 号：R687.4[医药卫生—骨科学]