Department of Physiotherapy, QEII Jubilee Hospital, Queensland Health, Brisbane, Queensland, Australia.
J Arthroplasty. 2012 Mar;27(3):347-353.e1. doi: 10.1016/j.arth.2011.06.005. Epub 2011 Aug 9.
The medial parapatellar (MP) approach in total knee arthroplasty is more common, but the subvastus (SV) approach is less insulting to the quadriceps. Whether the SV approach affords better outcomes was investigated using 90 participants with knee osteoarthritis, randomized to receive either SV or MP approaches and followed for 18 months. The primary outcome was the American Knee Society Score (AKSS); secondary outcomes included pain, knee range, quadriceps lag, Oxford Knee Score, 3-m timed "Up and Go" test, days to straight leg raise, surgeon perceived difficulty, operation duration, and length of stay. Analysis (n = 76) revealed no significant difference in AKSS (P = .076) or other outcomes, except the following: AKSS Functional scores at 12 and 18 months, favoring the MP (P = .032 and P = .028 respectively); surgeon's perceived difficulty, favoring the MP (P = .001); and days to straight leg raise, favoring the SV (P = .044). This study found that the SV approach offers no clinical benefit over the MP approach.
在全膝关节置换术中，内侧髌旁（MP）入路更为常见，但股四头肌下入路（SV）对股四头肌的损伤更小。本研究使用 90 例膝关节骨关节炎患者，随机分为 SV 组和 MP 组，随访 18 个月，旨在探讨 SV 入路是否能提供更好的结果。主要结果是美国膝关节协会评分（AKSS）；次要结果包括疼痛、膝关节活动度、股四头肌滞后、牛津膝关节评分、3 米定时“站起来和走”测试、直腿抬高天数、术者感知难度、手术时间和住院时间。分析（n = 76）发现 AKSS 或其他结果无显著差异（P =.076），除以下结果外：AKSS 功能评分在 12 个月和 18 个月时，MP 组更优（P =.032 和 P =.028）；术者感知难度，MP 组更优（P =.001）；直腿抬高天数，SV 组更优（P =.044）。本研究发现，SV 入路与 MP 入路相比，并没有临床优势。
