Abdel M P, Della Valle C J
Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612, USA.
Bone Joint J. 2016 Jan;98-B(1 Suppl A):113-5. doi: 10.1302/0301-620X.98B1.36315.
A key to the success of revision total knee arthroplasty (TKA) is a safe surgical approach using an exposure that minimises complications. In most patients, a medial parapatellar arthrotomy with complete synovectomy is sufficient. If additional exposure is needed, a quadriceps snip performed through the quadriceps tendon often provides the additional exposure required. It is simple to perform and does not alter the post-operative rehabilitative protocol. In rare cases, in which additional exposure is needed, or when removal of a cemented long-stemmed tibial component is required, a tibial tubercle osteotomy (TTO) may be used. Given the risk of post-operative extensor lag, a V-Y quadricepsplasty is rarely indicated and usually considered only if TTO is not possible.
翻修全膝关节置换术（TKA）成功的关键在于采用安全的手术入路，即通过最小化并发症的暴露方式。对于大多数患者，采用内侧髌旁关节切开术并完全切除滑膜就足够了。如果需要额外的暴露，经股四头肌肌腱进行股四头肌剪开术通常可提供所需的额外暴露。该操作简单，且不改变术后康复方案。在极少数需要额外暴露的情况下，或者需要取出骨水泥固定的长柄胫骨部件时，可采用胫骨结节截骨术（TTO）。鉴于术后伸肌滞后的风险，很少需要进行V-Y股四头肌成形术，通常仅在无法进行TTO时才考虑。
