Aslam Mohammed Ammar, Sabir Aamir Bin, Tiwari Vivek, Abbas Sohail, Tiwari Anurag, Singh Pritish
Department of Orthopaedics, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India.
Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.
J Knee Surg. 2017 Oct;30(8):793-797. doi: 10.1055/s-0036-1597978. Epub 2017 Jan 13.
The purpose of this randomized study was to compare clinical and surgical outcomes of total knee replacements (TKRs) in the early postoperative period using midvastus approach versus medial parapatellar approach in Asian population in a double blind manner. Forty-two knees each were operated using midvastus approach and the medial parapatellar approach. Clinical parameters that were evaluated included Knee Society score (KSS); knee pain using visual analogue scale (VAS) on day 1, 1 week, and 1 month; time required to straight leg raise (SLR); patellar tracking; mean extensor lag at 1 week and 1 month; and time of discharge from the hospital. Surgical parameters that were evaluated included tourniquet time, incidence of lateral retinacular release, estimated blood loss, and any complications during the surgery. KSS at 1 week and 1 month postoperatively were significantly higher in the midvastus group as compared with medial parapatellar group; though similar at 3 months, 6 months, and 1 year. The patients in midvastus group required fewer number of lateral retinacular releases; achieved SLR earlier; had less mean extensor lag at 1 week; had less mean VAS score at day 1, 1 week, and 1 month; and had shorter hospital stay. There was no significant difference in the mean tourniquet time and estimated blood loss. One patient had patellar maltracking in the medial parapatellar group as compared with none in midvastus group. Midvastus approach to TKR results in quicker functional recovery with early discharge and rehabilitation in the Asian population as compared with medial parapatellar approach.
这项随机研究的目的是采用双盲方式比较亚洲人群中，术后早期使用股中肌入路与髌旁内侧入路进行全膝关节置换术（TKR）的临床和手术结果。分别采用股中肌入路和髌旁内侧入路对42个膝关节进行手术。评估的临床参数包括膝关节协会评分（KSS）；术后第1天、1周和1个月时使用视觉模拟量表（VAS）评估的膝关节疼痛；直腿抬高（SLR）所需时间；髌骨轨迹；术后1周和1个月时的平均伸肌滞后；以及出院时间。评估的手术参数包括止血带使用时间、外侧支持带松解发生率、估计失血量以及手术期间的任何并发症。与髌旁内侧组相比，股中肌组术后1周和1个月时的KSS显著更高；尽管在3个月、6个月和1年时相似。股中肌组患者需要进行外侧支持带松解的次数更少；更早实现SLR；术后1周时平均伸肌滞后更小；术后第1天、1周和1个月时平均VAS评分更低；住院时间更短。平均止血带使用时间和估计失血量没有显著差异。髌旁内侧组有1例患者出现髌骨轨迹不良，而股中肌组无此情况。与髌旁内侧入路相比，亚洲人群中采用股中肌入路进行TKR可实现更快的功能恢复，并能早期出院和康复。
