中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (4): 552-557.doi: 10.12307/2022.751

• 人工假体 artificial prosthesis • 上一篇    下一篇

经股内侧肌下入路行内轴型全膝关节假体置换的优势

魏  波1,2,姚庆强1,2,唐  成1,2,李旭祥1,2,徐  燕1,2,王黎明1,2   

  1. 1南京医科大学附属南京医院(南京市第一医院)骨科,江苏省南京市   210006;2南京医科大学数字医学研究所,江苏省南京市   210006
  • 收稿日期:2021-10-18 接受日期:2021-11-17 出版日期:2023-02-08 发布日期:2022-06-22
  • 通讯作者: 王黎明,硕士,主任医师,博士生导师,南京医科大学附属南京医院(南京市第一医院)骨科,江苏省南京市 210006;南京医科大学数字医学研究所,江苏省南京市 210006
  • 作者简介:魏波,男,1985年生,安徽省全椒县人,汉族,2016年南京医科大学毕业,博士,主治医师,主要从事骨与关节外科、数字骨科方面的研究。
  • 基金资助:
    国家自然科学基金项目(81702148),项目负责人:魏波;江苏省自然科学基金项目(BK20170139),项目负责人:魏波

Advantage of medial pivot prosthesis in total knee arthroplasty via medial subvastus approach

Wei Bo1, 2, Yao Qingqiang1, 2, Tang Cheng1, 2, Li Xuxiang1, 2, Xu Yan1, 2, Wang Liming1, 2   

  1. 1Department of Orthopedics, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, Jiangsu Province, China; 2Digital Medicine Institute, Nanjing Medical University, Nanjing 210006, Jiangsu Province, China
  • Received:2021-10-18 Accepted:2021-11-17 Online:2023-02-08 Published:2022-06-22
  • Contact: Wang Liming, Master, Chief physician, Doctoral supervisor, Department of Orthopedics, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, Jiangsu Province, China; Digital Medicine Institute, Nanjing Medical University, Nanjing 210006, Jiangsu Province, China
  • About author:Wei Bo, MD, Attending physician, Department of Orthopedics, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, Jiangsu Province, China; Digital Medicine Institute, Nanjing Medical University, Nanjing 210006, Jiangsu Province, China
  • Supported by:
    the National Natural Science Foundation of China, No. 81702148 (to WB); the Natural Science Foundation of Jiangsu Province, No. BK20170139 (to WB)

摘要:

文题释义:
股内侧肌下入路:沿股内侧肌内下缘作L形切口,由后向前切开关节囊,再向下沿髌旁内侧入路显露关节腔,将股四头肌及髌骨推向外侧,不翻转髌骨。
内轴型全膝关节假体:是近年来出现的一种微创膝关节假体,其设计基于正常膝关节的运动学原理,是以内侧胫-股关节为轴,在屈曲过程中保持单一曲率半径,外侧胫-股关节发生后滚运动的内轴运动模式。

背景:目前全膝关节置换最常用的是内侧髌旁入路,但由于其对股四头肌腱的损伤,可能导致后期伸肌装置的弱化,进而影响患者的长期功能恢复。
目的:评估经股内侧肌下入路行内轴型膝关节假体全膝关节置换的优势。
方法:选取2018年8月至2019年10月期间收治的单侧膝骨关节炎患者,均采用内轴型膝关节假体进行全膝关节置换,其中26例为经股内侧肌下入路,27例为经内侧髌旁入路。两组患者在年龄、性别分布、体质量指数及术前血红蛋白、目测类比疼痛评分、膝关节纽约特种外科医院膝关节评分(HSS评分)和膝关节活动度方面比较,差异均无显著性意义(P > 0.05),具有可比性。对比分析两组手术切口长度、手术时间、术后首次直腿抬高时间、术后首次下床活动时间和术后住院时间;评估两组术后目测类比疼痛评分、膝关节HSS评分和膝关节活动度。
结果与结论:①股内侧肌下入路组患者的平均手术切口长度、术后首次直腿抬高时间、术后首次下床活动时间和术后住院时间均短于经内侧髌旁入路组(P < 0.05),手术时间比较差异无显著性意义(P > 0.05);②术后2 d,股内侧肌下入路组患者的目测类比疼痛评分低于内侧髌旁入路组(P < 0.001);术后1个月两组差异无显著性意义(P=0.474);③术后1,3个月,股内侧肌下入路组患者的膝关节HSS 评分显著高于内侧髌旁入路组(P < 0.001),术后1年两组差异无显著性意义(P=0.656);④术后1个月,股内侧肌下入路组患者的膝关节活动度显著高于内侧髌旁入路组(P < 0.001),术后3个月和1年两组差异无显著性意义(P=0.298,P=0.999);⑤采用股内侧肌下入路行全膝关节置换,不损伤股内侧肌腱,保留了伸肌装置,在较少软组织损伤的同时,便于内轴型膝关节假体的安装和术中内轴运动的评估,能显著改善置换后患肢的疼痛肿胀,更有利于早期功能锻炼。

https://orcid.org/0000-0001-5459-1414 (魏波)

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 人工全膝关节置换术, 内轴型膝关节假体, 股内侧肌下入路, 伸肌装置

Abstract: BACKGROUND: The most commonly used approach for total knee arthroplasty is the medial parapatellar approach, but due to its damage to the quadriceps tendon, it may lead to the weakening of the extensor device in the later stage, thus affecting the long-term functional recovery of patients.  
OBJECTIVE: To evaluate the advantage of total knee arthroplasty with medial pivot prosthesis through medial subvastus approach.  
METHODS: Patients with unilateral knee osteoarthritis who underwent total knee arthroplasty with medial pivot prosthesis from August 2018 to October 2019 were enrolled in this study. Of them, 26 patients received medial subvastus approach and 27 patients received medial parapatellar approach. There were no significant differences in age, sex distribution, body mass index, preoperative hemoglobin, visual analogous scale pain score, knee joint score of Hospital for Special Surgery, and knee range of motion between the two groups (P > 0.05). The operative incision length, operative time, the first postoperative straight leg raising time, the first postoperative activity time out of bed and the postoperative hospitalization time were compared and analyzed between the two groups. Postoperative visual analogous scale pain score, knee Hospital for Special Surgery score, and range of motion of the knee joint were evaluated in both groups. 
RESULTS AND CONCLUSION: (1) The mean incision length, the first postoperative straight leg elevation time, the first postoperative movement time, and the postoperative hospitalization time in the medial subvastus approach group were significantly shorter than those in the medial parapellar approach group (P < 
0.05). There was no significant difference in the operative time between the two groups (P > 0.05). (2) At 2 days after surgery, the visual analogous scale pain score in the medial subvastus approach group was significantly lower than that in the medial parapatellar approach group (P < 0.001). At 1 month after operation, there was no significant difference in visual analogous scale pain scores between the two groups (P = 0.474). (3) The knee Hospital for Special Surgery score of patients in the medial subvastus approach group was significantly higher than that in the medial parapellar approach group at 1 and 3 months after surgery (P < 0.001). At 1 year after surgery, there was no significant difference in knee Hospital for Special Surgery score between the two groups (P=0.656). (4) At 1 month after surgery, the range of motion of knee joint in the medial subvastus approach group was significantly higher than that in the medial parapatellar approach group (P < 0.001). At 3 months and 1 year after surgery, there was no significant difference in the range of motion of knee joint between the two groups (P=0.298, P=0.999). (5) The use of medial subvastus approach for total knee arthroplasty does not damage the medial vastus tendon, and the extensor device is retained, which is convenient for the installation of medial pivot prosthesis and intraoperative evaluation of medial pivot movement. It can significantly improve the pain and swelling of the limb after operation and effectively promote the early functional exercise. 

Key words: total knee arthroplasty, medial pivot knee joint prosthesis, medial subvastus approach, extensor device

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