Della Valle Craig J, Berger Richard A, Rosenberg Aaron G
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
Clin Orthop Relat Res. 2006 May;446:59-68. doi: 10.1097/01.blo.0000214434.64774.d5.
Safely obtaining adequate exposure at the time of revision total knee arthroplasty is an integral step in successfully performing the procedure. A medial capsular approach combined with an extensive intraarticular synovectomy provides adequate exposure for most patients. If further exposure is required, a quadriceps snip can be used to free the proximal extensor mechanism. The benefits of this approach include its technically simple nature and an unaltered postoperative rehabilitation regimen. We report a series of 126 consecutive revision knee procedures in which a medial capsular approach was adequate in 111 cases, representing 92% of the patients with an intact extensor mechanism. A quadriceps snip was required in nine cases. If more extensive exposure is required for an excessively stiff or difficult to expose knee, a tibial tubercle osteotomy or V-Y quadricepsplasty provides wider exposure.
Therapeutic study, level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.
在翻修全膝关节置换术时安全获得足够的显露是成功实施该手术的一个重要步骤。内侧关节囊入路联合广泛的关节内滑膜切除术可为大多数患者提供足够的显露。如果需要进一步显露，可采用股四头肌切断术来松解近端伸肌机制。该方法的优点包括技术操作简单以及术后康复方案未改变。我们报告了连续126例翻修膝关节手术，其中111例采用内侧关节囊入路就足够了，占伸肌机制完整患者的92%。9例需要进行股四头肌切断术。如果对于过于僵硬或难以显露的膝关节需要更广泛的显露，胫骨结节截骨术或V-Y股四头肌成形术可提供更广泛的显露。
治疗性研究，IV级（病例系列）。有关证据水平的完整描述，请参阅作者指南。
