【摘要】：背景全膝關節(jié)置換術（total knee arthroplasty,TKA）主要用于治療嚴重晚期骨關節(jié)病，比如類風濕性關節(jié)炎、骨性關節(jié)炎、創(chuàng)傷性關節(jié)炎等嚴重關節(jié)炎癥。目前，較為經(jīng)典常用的TKA手術入路有髕旁內(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，多種手術方法中，股內(nèi)側(cè)肌中間入路被許多專家看好，因為這一入路對股四頭肌內(nèi)側(cè)結(jié)構(gòu)破壞較少，在后期功能恢復中占有優(yōu)勢，并且對于施術部位的破壞較少，容易恢復膝關節(jié)的本體感覺，這一入路的手術施展也比較容易，可以在很好的暴露視野下施展手術。對于這一入路也有批評的聲音，因為股內(nèi)側(cè)肌中間入路有大量失血以及手術部位暴露時間長的問題，認為髕旁內(nèi)側(cè)入路比股內(nèi)側(cè)肌中間入路占優(yōu)勢，另外也有學者認為微創(chuàng)小切口入路效果會更好，對于這些入路本文并沒有做深入探討研究，本文主要對內(nèi)側(cè)髕旁入路和股內(nèi)側(cè)肌入路做了對比研究，以比較兩者的優(yōu)劣。 目的探究初次全膝關節(jié)置換術采用股內(nèi)側(cè)肌中間入路治療后對功能恢復訓練的影響，同初次全膝關節(jié)置換術采用髕旁內(nèi)側(cè)入路后對功能恢復訓練的影響進行比較。 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、術前HSS評分、術前關節(jié)活動度都沒有明顯差異的42例膝關節(jié)骨性關節(jié)炎患者。將42名患者分為兩組，兩組采用同樣的假體設計方案和固定方案。手術半年后對患者的各項參數(shù)進行對比測量，需要對比的臨床參數(shù)有直腿抬高時間、術后休息和活動時疼痛程度、手術并發(fā)癥、主動屈曲到90°的時間等。需要對比的外科參數(shù)有術中失血量、手術時間、麻醉時間、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。兩組手術麻醉時間，，切口長度,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統(tǒng)計學意義，經(jīng)股內(nèi)側(cè)肌入路組的膝關節(jié)術中失血較少[(300±50) mL，(380±55)mL, P 0.05]，術后1周內(nèi)疼痛較輕（P 0.05），能較早地進行主動直腿抬高運動[(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]，術后7d活動度改善較快[(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節(jié)置換術的有效安全入路。。 2.經(jīng)股內(nèi)側(cè)肌入路較髕旁入路出血更少，術后疼痛輕，早期關節(jié)功能恢復更快，屈曲活動度更高。 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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