【摘要】：背景全膝關(guān)節(jié)置換術(shù)（total knee arthroplasty,TKA）主要用于治療嚴(yán)重晚期骨關(guān)節(jié)病，比如類風(fēng)濕性關(guān)節(jié)炎、骨性關(guān)節(jié)炎、創(chuàng)傷性關(guān)節(jié)炎等嚴(yán)重關(guān)節(jié)炎癥。目前，較為經(jīng)典常用的TKA手術(shù)入路有髕旁內(nèi)側(cè)入路和股內(nèi)側(cè)肌入路。另外，目前常用的入路還有經(jīng)股內(nèi)側(cè)肌中間入路、正中入路、外側(cè)髕旁入路、微創(chuàng)小切口入路等，多種手術(shù)方法中，股內(nèi)側(cè)肌中間入路被許多專家看好，因?yàn)檫@一入路對(duì)股四頭肌內(nèi)側(cè)結(jié)構(gòu)破壞較少，在后期功能恢復(fù)中占有優(yōu)勢(shì)，并且對(duì)于施術(shù)部位的破壞較少，容易恢復(fù)膝關(guān)節(jié)的本體感覺(jué)，這一入路的手術(shù)施展也比較容易，可以在很好的暴露視野下施展手術(shù)。對(duì)于這一入路也有批評(píng)的聲音，因?yàn)楣蓛?nèi)側(cè)肌中間入路有大量失血以及手術(shù)部位暴露時(shí)間長(zhǎng)的問(wèn)題，認(rèn)為髕旁內(nèi)側(cè)入路比股內(nèi)側(cè)肌中間入路占優(yōu)勢(shì)，另外也有學(xué)者認(rèn)為微創(chuàng)小切口入路效果會(huì)更好，對(duì)于這些入路本文并沒(méi)有做深入探討研究，本文主要對(duì)內(nèi)側(cè)髕旁入路和股內(nèi)側(cè)肌入路做了對(duì)比研究，以比較兩者的優(yōu)劣。 目的探究初次全膝關(guān)節(jié)置換術(shù)采用股內(nèi)側(cè)肌中間入路治療后對(duì)功能恢復(fù)訓(xùn)練的影響，同初次全膝關(guān)節(jié)置換術(shù)采用髕旁內(nèi)側(cè)入路后對(duì)功能恢復(fù)訓(xùn)練的影響進(jìn)行比較。 方法自2010年1月至2013年3月，共有在年齡、性別、體重指數(shù)(BM I)是否合并其它內(nèi)科疾病、術(shù)前HSS評(píng)分、術(shù)前關(guān)節(jié)活動(dòng)度都沒(méi)有明顯差異的42例膝關(guān)節(jié)骨性關(guān)節(jié)炎患者。將42名患者分為兩組，兩組采用同樣的假體設(shè)計(jì)方案和固定方案。手術(shù)半年后對(duì)患者的各項(xiàng)參數(shù)進(jìn)行對(duì)比測(cè)量，需要對(duì)比的臨床參數(shù)有直腿抬高時(shí)間、術(shù)后休息和活動(dòng)時(shí)疼痛程度、手術(shù)并發(fā)癥、主動(dòng)屈曲到90°的時(shí)間等。需要對(duì)比的外科參數(shù)有術(shù)中失血量、手術(shù)時(shí)間、麻醉時(shí)間、外側(cè)支持帶松解的比例、暴露的難易程度等。 結(jié)果 42例患者42膝均完成本觀察。所有患者均未發(fā)生神經(jīng)血管損傷、感染、髕骨軌跡不良、切口皮膚牽拉性壞死等并發(fā)癥。兩組手術(shù)麻醉時(shí)間，，切口長(zhǎng)度,扶他林追加量，X線片上的假體力線以及外側(cè)支持帶松解率等方面的差異均無(wú)統(tǒng)計(jì)學(xué)意義，經(jīng)股內(nèi)側(cè)肌入路組的膝關(guān)節(jié)術(shù)中失血較少[(300±50) mL，(380±55)mL, P 0.05]，術(shù)后1周內(nèi)疼痛較輕（P 0.05），能較早地進(jìn)行主動(dòng)直腿抬高運(yùn)動(dòng)[(2±1)d，(5±1)d, P 0.01]，較早地屈曲到90°[(3±1)d，(7±2)d, P 0.01]，術(shù)后7d活動(dòng)度改善較快[(105°±10°)，(98°±9°), P 0.05]。 結(jié)論 1.經(jīng)股內(nèi)側(cè)肌入路和髕骨旁入路均是全膝關(guān)節(jié)置換術(shù)的有效安全入路。。 2.經(jīng)股內(nèi)側(cè)肌入路較髕旁入路出血更少，術(shù)后疼痛輕，早期關(guān)節(jié)功能恢復(fù)更快，屈曲活動(dòng)度更高。 3.經(jīng)股內(nèi)側(cè)肌入路早期療效滿意度高，值得臨床推廣和應(yīng)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 擄, 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 [( 鹵50) mL, (鹵55) mL, P)], mild pain within 1 week after operation, and early active straight leg elevation exercise [(2 鹵1) d, (5 鹵1) d, respectively. [2 鹵1) d, (5 鹵1] d, the pain was mild within 1 week after operation, and the active straight leg elevation exercise was performed earlier [(2 鹵1) d, (5 鹵1) d, P < 0.05], and the active straight leg elevation exercise was performed earlier [(2 鹵1) d, (5 鹵1) d]. P 0.01], the flexion reached 90 擄early [(3 鹵1) d, (7 鹵2) d, P 0.01], and the activity improved rapidly 7 days after operation [(105 擄鹵10 擄), (98 擄鹵9 擄), P 0.05]). Conclusion 1. Both medial thigh muscle approach and patellar approach are effective and safe approaches for total knee arthroplasty. two銆

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