[1]邓闽军,翁伟,孙振国,等.股内侧肌下入路与膝前正中旁侧入路全膝关节置换术治疗膝骨关节炎的比较研究[J].中医正骨,2021,33(01):15-21.
　DENG Minjun,WENG Wei,SUN Zhenguo,et al.A comparative study of total knee arthroplasty through subvastus approach versus anterior knee paramedian approach for treatment of knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(01):15-21.
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股内侧肌下入路与膝前正中旁侧入路全膝关节置换术治疗膝骨关节炎的比较研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期数:
2021年01期
页码:
15-21
栏目:
临床研究
出版日期:
2021-01-20

文章信息/Info

Title:
A comparative study of total knee arthroplasty through subvastus approach versus anterior knee paramedian approach for treatment of knee osteoarthritis
作者:
邓闽军; 翁伟; 孙振国; 杨红航
(湖州市第一人民医院,浙江 湖州 313000)
Author(s):
DENG Minjun; WENG Wei; SUN Zhenguo; YANG Honghang
The First People’s Hospital of Huzhou,Huzhou 313000,Zhejiang,China
关键词:
骨关节炎; 膝;  关节成形术; 置换; 膝;  手术入路;  临床试验
Keywords:
osteoarthritis; knee;  arthroplasty; replacement; knee;  operative approach;  clinical trial
摘要:
目的:比较股内侧肌下入路全膝关节置换术(total knee arthroplasty,TKA)和膝前正中旁侧入路TKA治疗膝骨关节炎的临床疗效。方法:回顾性分析120例膝骨关节炎患者的病例资料,其中采用股内侧肌下入路TKA治疗60例(股内侧肌下入路组),采用膝前正中旁侧入路TKA治疗60例(膝前正中旁侧入路组)。比较2组患者的切口长度、失血量、手术时间、初次主动直腿抬高时间、住院时间、膝关节疼痛视觉模拟量表(visual analogue scale,VAS)评分、膝关节活动度、美国特种外科医院(Hospital for Special Surgery,HSS)膝关节功能评分及简明健康状况调查表(short form 36 health survey questionnaire,SF-36)评分。结果:①一般指标。股内侧肌下入路组患者的切口长度、初次主动直腿抬高时间、住院时间均短于膝前正中旁侧入路组[(12.45±1.00)cm,(16.00±0.89)cm,t=-12.056,P=0.000;(2.35±0.40)d,(3.43±0.47)d,t=-7.816,P=0.000;(8.60±1.27)d,(9.85±0.88)d,t=-3.618,P=0.001],失血量少于膝前正中旁侧入路组[(375.85±12.51)mL,(396.25±7.93)mL,t=-6.161,P=0.000],手术时间长于膝前正中旁侧入路组[(74.65±4.89)min,(64.30±7.74)min,t=5.746,P=0.000]。②膝关节疼痛VAS评分。时间因素和分组因素存在交互效应(F=19.907,P=0.000); 2组患者的膝关节疼痛VAS评分比较,组间差异无统计学意义,即不存在分组效应(F=0.077,P=0.787); 手术前后不同时间点膝关节疼痛VAS评分的差异有统计学意义,即存在时间效应(F=0.021,P=0.000); 2组患者手术前后膝关节疼痛VAS评分均呈下降趋势(F=0.951,P=0.000; F=0.269,P=0.000); 但2组的下降趋势不完全一致; 术前、术后1个月、术后6个月、术后12个月2组患者膝关节疼痛VAS评分组间比较,差异无统计学意义[(5.90±0.64)分,(5.70±0.73)分,t=0.919,P=0.364;(2.70±0.47)分,(2.90±0.31)分,t=1.592,P=0.120;(2.05±0.76)分,(2.20±0.41)分,t=0.777,P=0.442;(1.55±0.51)分,(1.80±0.41)分,t=1.707,P=0.096]; 术后3 d股内侧肌下入路组膝关节疼痛VAS评分低于膝前正中旁侧入路组[(4.10±0.79)分,(4.55±0.51)分,t=2.143,P=0.039]。③膝关节活动度。时间因素和分组因素存在交互效应(F=11.204,P=0.000); 2组患者的膝关节活动度比较,组间差异无统计学意义,即不存在分组效应(F=0.782,P=0.921); 手术前后不同时间点膝关节活动度的差异有统计学意义,即存在时间效应(F=5.367,P=0.000); 2组患者手术前后膝关节活动度均呈上升趋势(F=7.541,P=0.000; F=6.247,P=0.000); 但2组的上升趋势不完全一致; 术前及术后12个月,2组患者膝关节活动度组间比较,差异无统计学意义(51.50°±6.51°,52.35°±5.87°,t=1.853,P=0.072; 110.25°±3.43°,105.50°±3.20°,t=4.525,P=0.096); 术后3 d、术后1个月、术后6个月,股内侧肌下入路组膝关节活动度均高于膝前正中旁侧入路组(67.00°±2.99°,63.00°±2.51°,t=4.579,P=0.000; 97.70°±5.49°,93.72°±6.46°,t=2.083,P=0.044; 103.75°±2.75°,100.00°±2.29°,t=4.682,P=0.000)。④HSS膝关节功能评分。时间因素和分组因素存在交互效应(F=16.513,P=0.000); 2组患者的HSS膝关节功能评分比较,组间差异无统计学意义,即不存在分组效应(F=0.954,P=0.745); 手术前后不同时间点HSS膝关节功能评分的差异有统计学意义,即存在时间效应(F=6.7821,P=0.000); 2组患者手术前后HSS膝关节功能评分均呈上升趋势(F=12.235,P=0.000; F=10.907,P=0.000); 但2组的上升趋势不完全一致; 术前、术后6个月及术后12个月,2组患者HSS膝关节功能评分组间比较,差异无统计学意义[(61.00±4.76)分,(60.50±3.59)分,t=0.375,P=0.710;(82.35±2.50)分,(80.50±4.26)分,t=1.675,P=0.102;(87.20±1.47)分,(86.35±1.27)分,t=1.956,P=0.058]; 术后3 d、术后1个月,股内侧肌下入路组HSS膝关节功能评分均高于膝前正中旁侧入路组[(72.25±4.13)分,(68.75±6.04)分,t=2.139,P=0.039;(76.50±5.16)分,(73.25±3.35)分,t=2.363,P=0.023]。⑤SF-36健康调查简表评分。末次随访时,股内侧肌下入路组患者的SF-36健康调查简表评分高于膝前正中旁侧入路组[(76.55±2.65)分,(74.40±3.00)分,t=2.405,P=0.021]。结论:股内侧肌下入路TKA治疗膝骨关节炎,与膝前正中旁侧入路TKA相比,短期临床疗效较好,有利于提高患者生活质量,且切口长度、初次主动直腿抬高时间、住院时间较短,术中失血量较少,但手术时间较长。
Abstract:
To compare the clinical curative effects of total knee arthroplasty(TKA)through subvastus approach(SVA)versus anterior knee paramedian approach(PMA)for treatment of knee osteoarthritis(KOA).Methods:The medical records of 120 KOA patients were analyzed retrospectively.Sixty patients were treated with TKA through SVA(SVA group),while the others were treated with TKA through anterior knee PMA(PMA group).The incision length,intraoperative blood loss,operative time,initial active straight-leg-raise(ASLR)time,hospital stays,knee pain visual analogue scale(VAS)scores,knee range of motion(ROM),Hospital for Special Surgery(HSS)knee function scores and the short form 36 health survey questionnaire(SF-36)scores were recorded and compared between the 2 groups.Results:The incision length,initial ASLR time and hospital stays were shorter,the intraoperative blood loss was less and the operative time was longer in SVA group compared to PMA group(12.45±1.00 vs 16.00±0.89 cm,t=-12.056,P=0.000; 2.35±0.40 vs 3.43±0.47 days,t=-7.816,P=0.000; 8.60±1.27 vs 9.85±0.88 days,t=-3.618,P=0.001; 375.85±12.51 vs 396.25±7.93 mL,t=-6.161,P=0.000; 74.65±4.89 vs 64.30±7.74 minutes,t=5.746,P=0.000).There was interaction between time factor and group factor in knee pain VAS scores(F=19.907,P=0.000).et al

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备注/Memo

备注/Memo:
基金项目:浙江省基础公益研究计划项目(LGF20H060009)
通讯作者:孙振国 E-mail:775200057@qq.com
更新日期/Last Update: 2021-01-20