CAJ | 학술논문

背景：目前国内全膝关节置换以内侧髌旁入路为主，创伤大、恢复慢，而经股内侧肌下入路更符合正常解剖，能完整保留伸膝装置，临床对于二者的相关比较研究极少。 　　目的：对比经股内侧肌下入路与内侧髌旁入路行全膝关节置换的早期疗效。 　　方法：2009年1月至2010年1月，55例(70膝)膝关节病变患者被随机分为股内侧肌下入路组26例(35膝)和内侧髌旁入路组29例(35膝)，分别采用经股内侧肌下入路与内侧髌旁入路行全膝关节置换。比较2组患者切口长度、手术时间、置换后引流量、依托考昔片追加量、疼痛度、直腿抬高时间、起始下地时间、住院时间、膝关节活动度、膝关节功能评分、假体力线对位以及并发症情况。所有假体均选用 Johnson&Johnson公司旋转平台的Sigma型假体。 　　结果与结论：55例患者获得12-24个月随访，均未出现感染、下肢深静脉血栓、血管神经损伤、关节不稳、假体松动或移位等并发症。所有假体均获得正确的力线对位。股内侧肌下入路组患者置换手术时间大于内侧髌旁入路组(P=0.00)，而切口长度、置换后引流量、依托考昔片追加量、目测类比疼痛评分、直腿抬高时间、起始下地时间、住院时间、置换后3 d 膝关节活动度及美国特种外科医院评分均优于内侧髌旁入路组(P <0.05)。置换后3个月膝关节活动度、膝关节功能评分2组差异无显著性意义。提示经股内侧肌下入路全膝关节置换早期疗效显著优于经内侧髌旁入路，而2种入路在假体力线对位方面无差异。
　　배경：목전국내전슬관절치환이내측빈방입로위주，창상대、회복만，이경고내측기하입로경부합정상해부，능완정보류신슬장치，림상대우이자적상관비교연구겁소。 　　목적：대비경고내측기하입로여내측빈방입로행전슬관절치환적조기료효。 　　방법：2009년1월지2010년1월，55례(70슬)슬관절병변환자피수궤분위고내측기하입로조26례(35슬)화내측빈방입로조29례(35슬)，분별채용경고내측기하입로여내측빈방입로행전슬관절치환。비교2조환자절구장도、수술시간、치환후인류량、의탁고석편추가량、동통도、직퇴태고시간、기시하지시간、주원시간、슬관절활동도、슬관절공능평분、가체력선대위이급병발증정황。소유가체균선용 Johnson&Johnson공사선전평태적Sigma형가체。 　　결과여결론：55례환자획득12-24개월수방，균미출현감염、하지심정맥혈전、혈관신경손상、관절불은、가체송동혹이위등병발증。소유가체균획득정학적력선대위。고내측기하입로조환자치환수술시간대우내측빈방입로조(P=0.00)，이절구장도、치환후인류량、의탁고석편추가량、목측류비동통평분、직퇴태고시간、기시하지시간、주원시간、치환후3 d 슬관절활동도급미국특충외과의원평분균우우내측빈방입로조(P <0.05)。치환후3개월슬관절활동도、슬관절공능평분2조차이무현저성의의。제시경고내측기하입로전슬관절치환조기료효현저우우경내측빈방입로，이2충입로재가체력선대위방면무차이。
BACKGROUND:Now, domestic total knee arthroplasty surgeries mainly use medial parapatel ar approach, with the disadvantages of large trauma and slower recovery. The quadriceps sparing approach is more accorded with normal anatomy, which can keep the knee extension system intact. The clinical comparison between quadriceps sparing approach and medial parapatel ar approach is rare. OBJECTIVE:To compare the early effect of total knee arthroplasty through quadriceps sparing approach and medial parapatel ar approach. METHODS:From January 2009 to January 2010, 55 patients (70 knees) were randomly divided into quadriceps sparing approach group (n=26, 35 knees) and medial parapatel ar approach group (n=29, 35 knees). Patients in two groups received total knee arthroplasty through quadriceps sparing approach and medial parapatel ar approach respectively. The incision length, operative time, postoperative drainage volume, additional amount of etoricoxib tablets, pain degree, straight leg raising time, start walking time, hospitalization time, range of motion of knee joint, Hospital for Special Surgery Knee Score, radiographic alignment of al components and complications were compared between two groups. Al the prostheses used in this study were the Sigma type prostheses provided by the rotation platform of Johnson&Johnson Company. RESULTS AND CONCLUSION:Al the patients were fol owed-up for 12-24 months without infections, deep vein thrombosis, neurovascular injury, prosthesis instability, prosthesis loosening or displacement. Position of al the prostheses was normal in patients. The operative time in the quadriceps sparing approach group was longer than that in the medial parapatel ar approach group (P=0.00), while the incision length, postoperative drainage volume, additional amount of etoricoxib tablets, visual analog scale, straight leg raising time, start walking time, hospitalization time, range of motion of knee joint at 3 days after replacement and Hospital for Special Surgery Knee Score in the quadriceps sparing approach group were better than those in the medial parapatel ar approach group (P<0.05). There were no significant differences in range of motion of knee joint at 3 days after replacement and Hospital for Special Surgery Knee Score between two groups. The early effect of total knee arthroplasty through quadriceps sparing approach is better than the medial parapatel ar approach, and there is no significant difference in prosthesis alignment between two methods.