Arnold M P, Friederich N F, Widmer H, Müller W
Klinik für Orthopädische Chirurgie und Traumatologie des Bewegungsapparates, Kantonsspital Bruderholz, CH-4101, Bruderholz, Schweiz.
Oper Orthop Traumatol. 1999 Sep;11(3):223-32. doi: 10.1007/BF02593984.
Simple standard approach to the knee for implantation of a total knee prosthesis.
Insertion of a total knee prosthesis.
Existing scars from medial or median approaches to the knee. The distance between old scar and planned incision should never be less than 5 cm.
Lateral parapatellar approach with judicious detachment of the iliotibial tract from Gerdy's tubercle. Opening of the compartment of tibialis anterior muscle. Mobilization of the patellar ligament together with Hoffa's fat pad in a medial direction. Osteotomy of the tibial tuberosity. Retraction of the distal part of the quadriceps, the patella, the patellar ligament and the tibial tuberosity medially, taking care not to detach the soft tissue from the medial side of the tuberosity. After insertion of the components refixation of the tibial tuberosity with two 3.5-mm cortical screws using the lag screw principle.
Unrestricted functional treatment possible starting day 1.
Since 1990 we implanted 702 tokal knee prostheses using the described approach. In 99% of the patients the osteotomy consolidated during the first 3 months without formation of a callus. Complications attributable to the osteotomy of the tuberosity were encountered in 7 patients (1%).
采用简单标准的膝关节入路植入全膝关节假体。
植入全膝关节假体。
膝关节内侧或正中入路留下的现有瘢痕。旧瘢痕与计划切口之间的距离绝不应小于5厘米。
采用髌旁外侧入路，谨慎地从Gerdy结节处松解髂胫束。切开胫骨前肌间隙。将髌韧带与Hoffa脂肪垫一起向内侧游离。胫骨结节截骨术。将股四头肌远端、髌骨、髌韧带和胫骨结节向内侧牵开，注意不要从结节内侧分离软组织。植入假体组件后，采用拉力螺钉技术用两枚3.5毫米皮质骨螺钉重新固定胫骨结节。
术后第1天即可开始进行无限制的功能治疗。
自1990年以来，我们采用上述入路植入了702例全膝关节假体。99%的患者截骨在最初3个月内愈合，未形成骨痂。7例患者（1%）出现了与结节截骨相关的并发症。
