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1、股内侧肌下入路全膝关节置换术初步观察探究【摘要】探讨股内侧肌下入路小切口微创全膝关节置换术的优点、风险及手术要点。[方法]自2005年4月〜2006年12月本院共行全膝关节置换术204例(344膝),其中传统切口(conventionincision,CI)置换组146例(246膝),经股内侧肌下入路微创(minimallyinvasive,MIS)置换组58例(98膝),均采用Zimmer公司NEXGEN-LPS人工全膝关节,记录麻醉时间、手术时间、住院时间;比较患者术后第一次下地时间,不同时间阶段行走距离、膝关节主动活动度、手术前后HSS评分以及手
2、术并发症情况。[结果]204例均获随访,时间4〜7个月(平均5个月),微创组和对照组麻醉时间、切口长度、手术时间、住院时间、下地时间比较差异均有统计学意义(u检验,P<;005),微创组麻醉时间、手术时间均大于对照组,切口长度、住院时间、下地时间均小于对照组。术后24h、1周、1月行走距离两组之间存在显著性差异(u检验,P<;O05),术后3个月行走距离两组之间无显著性差异(u检验,P>;005)o术后24h、1周、2周非负重主动活动度两组之间存在显著性差异(u检验,P<;O05),术后1个月行走距离两组之间无显著性差异(u检验,P&g
3、t;O05)oHSS评分术后24h、1周、2周膝关节HSS评分两组之间存在显著性差异(u检验,P<;O05),术后1月HSS评分两组之间无显著性差异(u检验,P>;005)o[结论]股内侧肌下入路小切口微创全膝关节置换术股四头肌损伤小,术后膝关节主动活动时间较早,膝关节功能恢复较快,术后远期步行距离、膝关节非负重主动活动度及HSS评分两者无明显差别。【关键词】全膝关节置换微创手术股内侧肌下入路Abstract[Objective]Toinvestigatetheadvantages,risksandkyepointsofminimallyinv
4、asivetotalkneearthroplastywithsubvastusapproach[Method]FromApril2005toDecember2006,204primarytotalkneearthroplastieswereperformed,amongthem146caseswithconventionincision(CI),58caseswithminimallyinvasivesubvastusapproach(MIS)Allkneeswereimplantedwiththesameprosthesis(NEXGEN-LPS,Z
5、iminer)Theanesthesiatime,operationtime,hospitalizationtimewererecordedThefirstwalkingtime,walkingdistance,activekneerangeofmotion,preoperativeandpostoperativeHSSScoreandthecomplicationswerecompared[Result]Totally204caseswerefollowedupandthemeanfollowuptimewas22months(range,13-36
6、months)Thedifferenceofanesthesistime,lengthofincision,operationtime,hospitalizationtime,walkingtimehadsignificancebetweentheCIandMISgroups(utest,P<;005)Thedifferenceofwalkingdistance3monthsafteroperationwasofnosignificanct(utest,P>;005)Thedifferenceofactiverangeofmotionin24h
7、ours,1week,2weekspostoperationhadsignificancebetweenthetwogroups(utest,P<;005)Thedifferenceofwalkingdistancehadnosignificancebetweenthetwogroups(utest,P>;005)ThedifferenceofHSSscorein24hours,1week,2weeksafteroperationhadsignificancebetweenthetwogroups(utest,P<;005)Thediffe
8、renceofHSSscorein1monthafteroperationhadnosigni