Bonutti Clinic, 1303 West Evergreen Avenue, Effingham, IL 62401, USA.
J Bone Joint Surg Am. 2010 Mar;92(3):575-82. doi: 10.2106/JBJS.I.00268.
The mini-subvastus and the mini-midvastus approaches are among the most common alternatives to the medial parapatellar approach for total knee arthroplasty. The purpose of this study was to compare the early clinical outcomes of these two approaches.
In this prospective, randomized study of fifty-one patients who underwent bilateral total knee arthroplasty, the mini-subvastus approach was used in one knee and the mini-midvastus approach, in the contralateral knee. There were forty-two women and nine men who had a mean age of seventy years at the time of the index arthroplasties, and they were followed for two years postoperatively. Clinical outcome was assessed and compared with use of the Knee Society pain and function scores, the straight-leg-raising test, range of motion, and isokinetic strength testing. Operating time and blood loss for each approach were also compared. In addition, patients were surveyed concerning which knee they preferred.
Comparisons of postoperative Knee Society scores between both approaches at the time of the two-year follow-up did not yield a significant difference in outcome. Isokinetic strength testing at twelve weeks postoperatively revealed no significant differences in muscle strength, with a mean extensor peak torque-to-body weight ratio of 0.14 Nm/kg for both groups. No significant difference was found with respect to total blood loss, straight-leg-raising test, range of motion, or patient preference. There was no clinically relevant difference in operative times between the two approaches.
The minimally invasive subvastus and midvastus approaches for total knee arthroplasty were both associated with excellent short-term clinical results. Some surgeons believe that the subvastus approach completely avoids damage to the quadriceps mechanism and therefore would be associated with improved muscle function. This prospective series did not identify a substantive difference between the two approaches. We believe that the decision between these surgical approaches should be based on surgeon preference and experience.
对于全膝关节置换术，迷你股外侧下入路和迷你股中间下入路是替代髌旁内侧入路最常用的两种方法。本研究旨在比较这两种方法的早期临床结果。
在这项前瞻性、随机研究中，对 51 例双侧全膝关节置换术患者，一侧膝关节采用迷你股外侧下入路，对侧膝关节采用迷你股中间下入路。其中 42 例为女性，9 例为男性，在进行指数性关节置换术时的平均年龄为 70 岁，术后随访 2 年。使用膝关节学会疼痛和功能评分、直腿抬高试验、活动范围和等速力量测试来评估和比较临床结果。还比较了两种方法的手术时间和失血量。此外，还调查了患者对哪条膝关节更满意。
在术后 2 年的随访中，比较两种方法的术后膝关节学会评分，结果在结果上没有显著差异。术后 12 周的等速力量测试显示，两组肌肉力量无显著差异，平均伸肌峰值扭矩与体重比均为 0.14 Nm/kg。两组间总失血量、直腿抬高试验、活动范围或患者偏好均无显著差异。两种方法的手术时间无明显差异。
全膝关节置换术的微创股外侧下入路和股中间下入路均具有良好的短期临床效果。一些外科医生认为，股外侧下入路完全避免了股四头肌机制的损伤，因此与改善肌肉功能有关。本前瞻性系列研究并未发现两种方法之间存在实质性差异。我们认为，这两种手术方法的选择应基于外科医生的偏好和经验。
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