小切口经股内侧肌入路行全膝关节置换术  

Total knee arthroplasty through mini midvastus approach

作　　者：宋兵华[1] 孙俊英[1] 石岩[1] 殷浩[1] 赖震[1] 

机构地区：[1]苏州大学附属第一医院骨科,江苏苏州215006

出　　处：《临床骨科杂志》2008年第3期198-201,共4页Journal of Clinical Orthopaedics

摘　　要：目的探讨小切口经股内侧肌入路行全膝关节置换术的早期临床疗效和特点。方法小切口经股内侧肌入路行全膝置换28例（30膝）。分别对术后切口长度、疼痛度、镇痛剂使用量、手术前后Hb减少量、输血量、引流量、直腿抬高时间、术后住院时间、假体力线对位,术后6、12周、1年的活动度（ROM）及术后1年膝关节HSS评分等观察指标进行疗效分析。结果28例患者均获得随访,时间1年-1年6个月。切口长度8.5-14（11.3±0.8）cm,VAS评分1.2-4（2.76±0.76）分,术后2例患者肌注75mg杜冷丁,5例口服塞来昔布（西乐葆）0.4g,余患者均未给予镇痛剂,引流量25-300（96.8±55.9）m、lHb减少10-55（25.5±10.5）g/L,距能直腿抬高时间1-8（3.8±1.57）d,术后住院6-14（8.6±2.0）d,术后6、12周、1年的平均ROM分别为107°±6.3°、117°±5.5°、121°±6°,1年HSS评分平均95分±1.7分;除有1例胫骨假体对位不良外,其余均获得正确的力线对位。结论小切口经股内侧肌入路行全膝关节置换,术后膝关节功能恢复快,早期疗效满意。Objective To evaluate the advantages and short-term clinical result of total knee arthroplasty （TKA） through mini midvastus approach. Methods 28 patients（30 knees） were undergone TKA using mini midvastus approach. Their clinical results were evaluated according to skin incision length, postoperative pain scores, the total doses of intramascular narcotic pain medication, postoperative amount of decreasing Hb, the total amount of blood transfusion, the total amount of drainage, active straight-leg raise time, postoperative length of hospital stay, radiographic alignment of all the components, postoperative range of motion at 6 weeks and 12 weeks and 1 year and postoperative HSS score at 1 year. Results All the patients were followed up for 1 - 1.5 year. The skin incision length was 8. 5 - 14（11.3 ±0.8）cm, and visual analog pain scale was 1.2 -4（2. 76 ±7.6） score. Only two cases were administrated by narcotic pain medication for 75 mg. 5 cases were orally administrated celecoxib for 0. 4 g. The total amount of drainage was 25 - 300 （ 96. 8 ± 55.9 ） ml, postoperative amount of decreasing Hb was 10 - 55 （22.5 ± 10. 5 ） g/L, active straight-leg raise time was 1 -8 （3.8 ± 1.57）days, postoperative length of stay was 6 - 14（ 8.6 ±2. 0）days, the mean ROM at 6 weeks postoperatively was 107° ± 6. 3°,1 17° ± 5.5° at 12 weeks and 121° ± 6°at 1 year, and HSS score at 1 year was 95 ± 1.7 score ; Position of all the components was normal in all patients except one case abnormal position of tibial prosthesis. Conclusions The mini midvastus approach is associated with a more rapid functional recovery and a more satisfactory short-term result.

关 键 词：全膝置换 膝关节 微创股内侧肌入路 

分 类 号：R687.4[医药卫生—骨科学]