Matsueda M, Gustilo R B
Department of Orthopaedic Surgery, Niigata University School of Medicine, Japan.
Clin Orthop Relat Res. 2000 Feb(371):161-8. doi: 10.1097/00003086-200002000-00020.
This retrospective study compared the outcome of two consecutive groups of patients having primary total knee arthroplasty. The arthroplasties were performed in the first group (169 arthroplasties in 143 patients) from 1988 to 1992 using a medial parapatellar approach, and in the second group (167 arthroplasties in 148 patients) from 1992 to 1996 using a subvastus approach. The patient outcomes were evaluated at 6 months, and were based on clinical and radiographic measures, occurrence of intraoperative lateral retinacular release, and incidence of postoperative patellar subluxation. There were no significant differences between the two groups for range of motion, Knee Society knee and function scores, and stair climbing ability. The patella tracked centrally in significantly more knees with the subvastus approach (139 of 167 knees, 83%) than with the parapatellar approach (107 of 169 knees, 63%). There were significantly fewer knees in the subvastus group requiring a lateral retinacular release (62 of 167 knees, 37%), compared with the parapatellar group (113 of 169 knees, 67%). The authors concluded that the subvastus approach led to improved patellar tracking and stability. Although the surgical and rehabilitative protocols were identical for both groups, the results may have been affected by changing circumstances during the 9-year period of the study.
这项回顾性研究比较了两组连续接受初次全膝关节置换术患者的治疗结果。第一组（143例患者，共169例置换术）于1988年至1992年采用髌旁内侧入路进行关节置换；第二组（148例患者，共167例置换术）于1992年至1996年采用股直肌下入路进行关节置换。在6个月时对患者的治疗结果进行评估，评估基于临床和影像学测量、术中外侧支持带松解的发生情况以及术后髌骨半脱位的发生率。两组在活动范围、膝关节协会膝关节和功能评分以及爬楼梯能力方面没有显著差异。与髌旁入路（169例膝关节中的107例，63%）相比，股直肌下入路组中髌骨轨迹位于中心的膝关节明显更多（167例膝关节中的139例，83%）。与髌旁入路组（169例膝关节中的113例，67%）相比，股直肌下入路组需要进行外侧支持带松解的膝关节明显更少（167例膝关节中的62例，37%）。作者得出结论，股直肌下入路可改善髌骨轨迹和稳定性。尽管两组的手术和康复方案相同，但研究的9年期间情况的变化可能影响了结果。
