系统评价股内侧肌入路与髌旁内侧入路的全膝置换术后的早期康复比较
发布时间：2019-06-13 21:37
【摘要】：背景全膝关节置换术（total knee arthroplasty,TKA）主要用于治疗严重晚期骨关节病，比如类风湿性关节炎、骨性关节炎、创伤性关节炎等严重关节炎症。目前，较为经典常用的TKA手术入路有髌旁内侧入路和股内侧肌入路。另外，目前常用的入路还有经股内侧肌中间入路、正中入路、外侧髌旁入路、微创小切口入路等，多种手术方法中，股内侧肌中间入路被许多专家看好，因为这一入路对股四头肌内侧结构破坏较少，在后期功能恢复中占有优势，并且对于施术部位的破坏较少，容易恢复膝关节的本体感觉，这一入路的手术施展也比较容易，可以在很好的暴露视野下施展手术。对于这一入路也有批评的声音，因为股内侧肌中间入路有大量失血以及手术部位暴露时间长的问题，认为髌旁内侧入路比股内侧肌中间入路占优势，另外也有学者认为微创小切口入路效果会更好，对于这些入路本文并没有做深入探讨研究，本文主要对内侧髌旁入路和股内侧肌入路做了对比研究，以比较两者的优劣。 目的探究初次全膝关节置换术采用股内侧肌中间入路治疗后对功能恢复训练的影响，同初次全膝关节置换术采用髌旁内侧入路后对功能恢复训练的影响进行比较。 方法自2010年1月至2013年3月，共有在年龄、性别、体重指数(BM I)是否合并其它内科疾病、术前HSS评分、术前关节活动度都没有明显差异的42例膝关节骨性关节炎患者。将42名患者分为两组，两组采用同样的假体设计方案和固定方案。手术半年后对患者的各项参数进行对比测量，需要对比的临床参数有直腿抬高时间、术后休息和活动时疼痛程度、手术并发症、主动屈曲到90°的时间等。需要对比的外科参数有术中失血量、手术时间、麻醉时间、外侧支持带松解的比例、暴露的难易程度等。 结果 42例患者42膝均完成本观察。所有患者均未发生神经血管损伤、感染、髌骨轨迹不良、切口皮肤牵拉性坏死等并发症。两组手术麻醉时间，，切口长度,扶他林追加量，X线片上的假体力线以及外侧支持带松解率等方面的差异均无统计学意义，经股内侧肌入路组的膝关节术中失血较少[(300±50) mL，(380±55)mL, P 0.05]，术后1周内疼痛较轻（P 0.05），能较早地进行主动直腿抬高运动[(2±1)d，(5±1)d, P 0.01]，较早地屈曲到90°[(3±1)d，(7±2)d, P 0.01]，术后7d活动度改善较快[(105°±10°)，(98°±9°), P 0.05]。 结论 1.经股内侧肌入路和髌骨旁入路均是全膝关节置换术的有效安全入路。。 2.经股内侧肌入路较髌旁入路出血更少，术后疼痛轻，早期关节功能恢复更快，屈曲活动度更高。 3.经股内侧肌入路早期疗效满意度高，值得临床推广和应用。
[Abstract]:Background Total knee arthroplasty (total knee arthroplasty,TKA) is mainly used in the treatment of severe advanced osteoarthropathy, such as rheumatoid arthritis, osteoarthritis, traumatic arthritis and other severe arthritis. At present, the more classical TKA approach is the medial patellar approach and the medial thigh muscle approach. In addition, at present, the commonly used approaches are intermediate approach of medial thigh muscle, median approach, lateral paratellar approach, minimally invasive small incision approach and so on. Among many surgical methods, the intermediate approach of medial thigh muscle is favored by many experts, because this approach has less damage to the medial structure of quadriceps femoris, has advantages in the later functional recovery, and has less damage to the site of operation, so it is easy to restore the Noumenon feeling of knee joint. This approach is also easier to perform and can be performed in a good exposure field. There are also critical voices about this approach, because there is a lot of blood loss and long exposure time in the middle approach of the medial thigh muscle. It is considered that the medial patellar approach is superior to the medial approach of the medial femoris muscle. In addition, some scholars believe that the minimally invasive small incision approach will be better. There is no in-depth study on these approaches. This paper mainly makes a comparative study of the medial patellar approach and the medial thigh muscle approach. In order to compare the advantages and disadvantages of the two. Objective to investigate the effect of medial thigh muscle intermediate approach on functional recovery training in primary total knee arthroplasty, and to compare the effect on functional recovery training after primary total knee arthroplasty with medial patellar approach. Methods from January 2010 to March 2013, 42 patients with osteoarthritis of knee joint had no significant difference in age, sex, body mass index (BM I) with other internal diseases, preoperative HSS score and preoperative range of motion. Forty-two patients were divided into two groups. The two groups were treated with the same artificial design and fixation. Six months after operation, the parameters of the patients were compared and measured. The clinical parameters needed to be compared were straight leg elevation time, pain degree during rest and activity after operation, surgical complications, active flexion to 90 掳, and so on. The surgical parameters need to be compared are intraoperative blood loss, operation time, anaesthesia time, the proportion of lateral support band release, the difficulty of exposure and so on. Results 42 knees of 42 patients completed this observation. There were no complications such as neurovascular injury, infection, poor patella track and skin traction necrosis in all patients. There was no significant difference in anaesthesia time, incision length, Fentalin addition, artificial body force line and release rate of lateral supporting band between the two groups. There was less blood loss during knee joint operation through medial thigh muscle approach [( 卤50) mL, (卤55) mL, P)], mild pain within 1 week after operation, and early active straight leg elevation exercise [(2 卤1) d, (5 卤1) d, respectively. [2 卤1) d, (5 卤1] d, the pain was mild within 1 week after operation, and the active straight leg elevation exercise was performed earlier [(2 卤1) d, (5 卤1) d, P < 0.05], and the active straight leg elevation exercise was performed earlier [(2 卤1) d, (5 卤1) d]. P 0.01], the flexion reached 90 掳early [(3 卤1) d, (7 卤2) d, P 0.01], and the activity improved rapidly 7 days after operation [(105 掳卤10 掳), (98 掳卤9 掳), P 0.05]). Conclusion 1. Both medial thigh muscle approach and patellar approach are effective and safe approaches for total knee arthroplasty. two銆
本文编号：2498834
[Abstract]:Background Total knee arthroplasty (total knee arthroplasty,TKA) is mainly used in the treatment of severe advanced osteoarthropathy, such as rheumatoid arthritis, osteoarthritis, traumatic arthritis and other severe arthritis. At present, the more classical TKA approach is the medial patellar approach and the medial thigh muscle approach. In addition, at present, the commonly used approaches are intermediate approach of medial thigh muscle, median approach, lateral paratellar approach, minimally invasive small incision approach and so on. Among many surgical methods, the intermediate approach of medial thigh muscle is favored by many experts, because this approach has less damage to the medial structure of quadriceps femoris, has advantages in the later functional recovery, and has less damage to the site of operation, so it is easy to restore the Noumenon feeling of knee joint. This approach is also easier to perform and can be performed in a good exposure field. There are also critical voices about this approach, because there is a lot of blood loss and long exposure time in the middle approach of the medial thigh muscle. It is considered that the medial patellar approach is superior to the medial approach of the medial femoris muscle. In addition, some scholars believe that the minimally invasive small incision approach will be better. There is no in-depth study on these approaches. This paper mainly makes a comparative study of the medial patellar approach and the medial thigh muscle approach. In order to compare the advantages and disadvantages of the two. Objective to investigate the effect of medial thigh muscle intermediate approach on functional recovery training in primary total knee arthroplasty, and to compare the effect on functional recovery training after primary total knee arthroplasty with medial patellar approach. Methods from January 2010 to March 2013, 42 patients with osteoarthritis of knee joint had no significant difference in age, sex, body mass index (BM I) with other internal diseases, preoperative HSS score and preoperative range of motion. Forty-two patients were divided into two groups. The two groups were treated with the same artificial design and fixation. Six months after operation, the parameters of the patients were compared and measured. The clinical parameters needed to be compared were straight leg elevation time, pain degree during rest and activity after operation, surgical complications, active flexion to 90 掳, and so on. The surgical parameters need to be compared are intraoperative blood loss, operation time, anaesthesia time, the proportion of lateral support band release, the difficulty of exposure and so on. Results 42 knees of 42 patients completed this observation. There were no complications such as neurovascular injury, infection, poor patella track and skin traction necrosis in all patients. There was no significant difference in anaesthesia time, incision length, Fentalin addition, artificial body force line and release rate of lateral supporting band between the two groups. There was less blood loss during knee joint operation through medial thigh muscle approach [( 卤50) mL, (卤55) mL, P)], mild pain within 1 week after operation, and early active straight leg elevation exercise [(2 卤1) d, (5 卤1) d, respectively. [2 卤1) d, (5 卤1] d, the pain was mild within 1 week after operation, and the active straight leg elevation exercise was performed earlier [(2 卤1) d, (5 卤1) d, P < 0.05], and the active straight leg elevation exercise was performed earlier [(2 卤1) d, (5 卤1) d]. P 0.01], the flexion reached 90 掳early [(3 卤1) d, (7 卤2) d, P 0.01], and the activity improved rapidly 7 days after operation [(105 掳卤10 掳), (98 掳卤9 掳), P 0.05]). Conclusion 1. Both medial thigh muscle approach and patellar approach are effective and safe approaches for total knee arthroplasty. two銆
本文编号：2498834
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