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[1]鄧閩軍,翁偉,孫振國,等.股內(nèi)側(cè)肌下入路與膝前正中旁側(cè)入路全膝關節(jié)置換術治療膝骨關節(jié)炎的比較研究[J].中醫(yī)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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股內(nèi)側(cè)肌下入路與膝前正中旁側(cè)入路全膝關節(jié)置換術治療膝骨關節(jié)炎的比較研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期數(shù):
2021年01期
頁碼:
15-21
欄目:
臨床研究
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:
鄧閩軍; 翁偉; 孫振國; 楊紅航
(湖州市第一人民醫(yī)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
關鍵詞:
骨關節(jié)炎; 膝;  關節(jié)成形術; 置換; 膝;  手術入路;  臨床試驗
Keywords:
osteoarthritis; knee;  arthroplasty; replacement; knee;  operative approach;  clinical trial
摘要:
目的:比較股內(nèi)側(cè)肌下入路全膝關節(jié)置換術(total knee arthroplasty,TKA)和膝前正中旁側(cè)入路TKA治療膝骨關節(jié)炎的臨床療效。方法:回顧性分析120例膝骨關節(jié)炎患者的病例資料,其中采用股內(nèi)側(cè)肌下入路TKA治療60例(股內(nèi)側(cè)肌下入路組),采用膝前正中旁側(cè)入路TKA治療60例(膝前正中旁側(cè)入路組)。比較2組患者的切口長度、失血量、手術時間、初次主動直腿抬高時間、住院時間、膝關節(jié)疼痛視覺模擬量表(visual analogue scale,VAS)評分、膝關節(jié)活動度、美國特種外科醫(yī)院(Hospital for Special Surgery,HSS)膝關節(jié)功能評分及簡明健康狀況調(diào)查表(short form 36 health survey questionnaire,SF-36)評分。結(jié)果:①一般指標。股內(nèi)側(cè)肌下入路組患者的切口長度、初次主動直腿抬高時間、住院時間均短于膝前正中旁側(cè)入路組[(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側(cè)入路組[(375.85±12.51)mL,(396.25±7.93)mL,t=-6.161,P=0.000],手術時間長于膝前正中旁側(cè)入路組[(74.65±4.89)min,(64.30±7.74)min,t=5.746,P=0.000]。②膝關節(jié)疼痛VAS評分。時間因素和分組因素存在交互效應(F=19.907,P=0.000); 2組患者的膝關節(jié)疼痛VAS評分比較,組間差異無統(tǒng)計學意義,即不存在分組效應(F=0.077,P=0.787); 手術前后不同時間點膝關節(jié)疼痛VAS評分的差異有統(tǒng)計學意義,即存在時間效應(F=0.021,P=0.000); 2組患者手術前后膝關節(jié)疼痛VAS評分均呈下降趨勢(F=0.951,P=0.000; F=0.269,P=0.000); 但2組的下降趨勢不完全一致; 術前、術后1個月、術后6個月、術后12個月2組患者膝關節(jié)疼痛VAS評分組間比較,差異無統(tǒng)計學意義[(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]; 術后3 d股內(nèi)側(cè)肌下入路組膝關節(jié)疼痛VAS評分低于膝前正中旁側(cè)入路組[(4.10±0.79)分,(4.55±0.51)分,t=2.143,P=0.039]。③膝關節(jié)活動度。時間因素和分組因素存在交互效應(F=11.204,P=0.000); 2組患者的膝關節(jié)活動度比較,組間差異無統(tǒng)計學意義,即不存在分組效應(F=0.782,P=0.921); 手術前后不同時間點膝關節(jié)活動度的差異有統(tǒng)計學意義,即存在時間效應(F=5.367,P=0.000); 2組患者手術前后膝關節(jié)活動度均呈上升趨勢(F=7.541,P=0.000; F=6.247,P=0.000); 但2組的上升趨勢不完全一致; 術前及術后12個月,2組患者膝關節(jié)活動度組間比較,差異無統(tǒng)計學意義(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); 術后3 d、術后1個月、術后6個月,股內(nèi)側(cè)肌下入路組膝關節(jié)活動度均高于膝前正中旁側(cè)入路組(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膝關節(jié)功能評分。時間因素和分組因素存在交互效應(F=16.513,P=0.000); 2組患者的HSS膝關節(jié)功能評分比較,組間差異無統(tǒng)計學意義,即不存在分組效應(F=0.954,P=0.745); 手術前后不同時間點HSS膝關節(jié)功能評分的差異有統(tǒng)計學意義,即存在時間效應(F=6.7821,P=0.000); 2組患者手術前后HSS膝關節(jié)功能評分均呈上升趨勢(F=12.235,P=0.000; F=10.907,P=0.000); 但2組的上升趨勢不完全一致; 術前、術后6個月及術后12個月,2組患者HSS膝關節(jié)功能評分組間比較,差異無統(tǒng)計學意義[(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]; 術后3 d、術后1個月,股內(nèi)側(cè)肌下入路組HSS膝關節(jié)功能評分均高于膝前正中旁側(cè)入路組[(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健康調(diào)查簡表評分。末次隨訪時,股內(nèi)側(cè)肌下入路組患者的SF-36健康調(diào)查簡表評分高于膝前正中旁側(cè)入路組[(76.55±2.65)分,(74.40±3.00)分,t=2.405,P=0.021]。結(jié)論:股內(nèi)側(cè)肌下入路TKA治療膝骨關節(jié)炎,與膝前正中旁側(cè)入路TKA相比,短期臨床療效較好,有利于提高患者生活質(zhì)量,且切口長度、初次主動直腿抬高時間、住院時間較短,術中失血量較少,但手術時間較長。
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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備注/Memo

備注/Memo:
基金項目:浙江省基礎公益研究計劃項目(LGF20H060009)
通訊作者:孫振國 E-mail:[email protected]
更新日期/Last Update: 2021-01-20