不同手术入路对全膝关节置换术后早期髌股关节功能的影响  

Effect of Different Surgical Approaches on the Early PatellofemoralJoint Function After Total Knee Arthroplasty

作　　者：吴明禹 李晓帆 吴理中 韩桂全[2] Wu Mingyu;Li Xiaofan;Wu Lizhong;Han Guiquan(School of Clinical Medicine,Weifang Medical University,Weifang 261042,China;Department of Joint Surgery,Affiliated Hospital of Weifang Medical University,Weifang 261000,China)

机构地区：[1]潍坊医学院临床医学院,山东潍坊261042 [2]潍坊医学院附属医院关节外科,山东潍坊261000

出　　处：《实用骨科杂志》2023年第12期1075-1080,共6页Journal of Practical Orthopaedics

摘　　要：目的比较经股内侧肌下入路与内侧髌旁入路对全膝关节置换术后早期髌股关节功能的影响。方法回顾性随机对照研究,选取2021年11月至2022年11月潍坊医学院附属医院因膝关节退行性疾病行全膝关节置换的患者80例,按照膝关节置换手术入路分为股内侧肌下入路(subvastus approach,SVA)组和内侧髌旁入路(medial parapatellar approach,MPA)组各40例。SVA组男11例,女29例;年龄55~77岁,平均(66.03±5.01)岁。MPA组男13例,女27例;年龄56~75岁,平均(65.78±4.42)岁。两组患者术前及术后1个月在Laurin位下分别拍摄屈膝30°及60°膝关节轴位片,通过测量髌骨位移距离及髌骨倾斜角评估髌骨侧向位移及倾斜程度。比较两组患者手术时间、术中髌骨外侧支持带松解情况、术后直腿抬高时间、术后不同时间点膝关节活动度(range of motion,ROM)、疼痛视觉模拟评分(visual analogue scale,VAS)、Lonner髌股评分、术中及术后并发症。结果SVA组术后1个月屈膝30°时髌骨位移距离(-1.91±1.94)mm,优于MPA组(-2.92±2.12)mm(P<0.05);屈膝60°时两组髌骨位移距离差异无统计学意义(P>0.05);SVA组术后1个月屈膝30°及60°髌骨倾斜角分别为(5.64±2.17)°、(5.81±2.13)°,MPA组为(6.63±2.12)°、(6.82±1.77)°,均较术前减小(P<0.05),且SVA组术后改善情况优于MPA组。SVA组手术时间(86.13±6.80)min长于MPA组(82.83±6.06)min(P<0.05),SVA组术中髌骨外侧支持带松解情况、术后直腿抬高时间及术后不同时间点ROM分别为65.0%、(26.25±6.71)h、(99.75±8.87)°、(106.53±6.67)°,优于MPA组的92.5%、(34.84±7.56)h、(89.93±11.30)°、(102.53±8.90)°。随着时间增加两组患者术后Lonner髌股评分呈增加趋势,VAS呈降低趋势,且术后不同时间点SVA组VAS及术后1个月、3个月Lonner髌股评分均优于MPA组(P<0.05),术后6个月Lonner髌股评分两组间差异无统计学意义(P>0.05)。结论相对于内侧髌旁入路,股内侧肌下入路对全膝关节�Objective To compare the effects of the subvastus approach and the medial parapatellar approach on the early patellofemoral joint function after total knee arthroplasty.Methods In this retrospective randomized controlled study,80 patients who underwent total knee arthroplasty for knee degenerative diseases at Affiliated Hospital of Weifang Medical University from November 2021 to November 2022 were selected.They were divided into two groups based on the surgical approach:the subvastus approach(SVA)and the medial parapatellar approach(MPA),with 40 cases in each.The SVA group comprised 11 males and 29 females,aged between 55 and 77 years,averaging(66.03±5.01)years.The MPA group comprised 13 males and 27 females,aged between 56 and 75 years,with an average age of(65.78±4.42)years.Axial knee films at 30°and 60°flexion in Laurin’s position were taken preoperatively and one month postoperatively in both groups to evaluate patellar lateral displacement and tilt angles.Operation time,intraoperative lateral patellar release,postoperative straight leg raising time,range of motion(ROM)at various postoperative stages,visual analogue scale(VAS)for pain,Lonner patellofemoral score,and intraoperative and postoperative complications were compared between groups.Results One month post-surgery,the SVA group exhibited a lateral patellar displacement of(-1.91±1.94)mm at 30°knee flexion,outperforming the MPA group(-2.92±2.12)mm(P<0.05).At 60°flexion,the difference in lateral patellar displacement between groups was not statistically significant(P>0.05).The postoperative patellar tilt angles at 30°and 60°knee flexion were(5.64±2.17)°and(5.81±2.13)°in the SVA group,and(6.63±2.12)°and(6.82±1.77)°in the MPA group,both showing significant reductions from preoperative measurements(P<0.05),with the SVA group exhibiting greater postoperative improvement.The operation time for the SVA group(86.13±6.80)min exceeded that of the MPA group(82.83±6.06)min(P<0.05).However,the SVA group had better outcomes in terms of intraoper

关 键 词：全膝关节置换 髌股关节 股内侧肌下入路 内侧髌旁入路 

分 类 号：R687.42[医药卫生—骨科学]