Department of Orthopaedics and Traumatology, Ankara Training and Research Hospital, 06534, Ankara, Turkey.
Department of Nuclear Medicine, Ankara Training and Research Hospital, Ankara, Turkey.
Knee Surg Sports Traumatol Arthrosc. 2018 Jun;26(6):1681-1690. doi: 10.1007/s00167-017-4690-8. Epub 2017 Aug 23.
The arthrotomy techniques of knee surgery may cause varying degrees of disruption to the tissue blood supply. The aim of this study was to investigate the effects of the medial parapatellar (MPPa), midvastus (MVa), subvastus (SVa) and lateral parapatellar (LPPa) approaches on regional tissue perfusion of the knee.
In this experimental study, a total of 28 female rabbits were applied with four different arthrotomy techniques as Group MPPa, Group MVa, Group SVa and Group LPPa. The blood supply of the tissue around the knee was examined by scintigraphic imaging including the perfusion reserve and T , and biochemical alteration of the oxidative stress parameters including malondialdehyde (MDA), fluorescent oxidation products (FlOPs), and histopathological findings were evaluated on tissue samples after 3 weeks.
The perfusion reserve was increased in all four groups compared to the healthy, contralateral knees. In the Group LPPa, the vascularity was significantly increased compared to the Group MPPa (p = 0.006). In the examination of biochemical parameters, the increase in MDA levels was statistically significant in the Group MPPa compared with the Group LPPa (p = 0.004), and in the Group MVa compared with the Group LPPa (p = 0.006). The increase in the value of MDA levels was striking in the Group MPPa and Group MVa compared with the control group (p = 0.004, p = 0.004, respectively). The increase in another oxidative stress parameter, the tissue FlOPs levels, was statistically significant in the Group MPPa compared with the control group (p = 0.035).
The LPPa and SVa caused less oxidative stress and less disruption of the muscle blood supply, in biochemical and scintigraphic parameters, compared to the MPPa and MVa. Therefore, in clinical practice, the SVa is preferable to the MPPa and MVa in total knee arthroplasty and the LPPa should be preferred more frequently in selected cases with critical soft tissue viability.
膝关节手术的关节切开技术可能会对组织血液供应造成不同程度的破坏。本研究旨在探讨内侧髌旁（MPPa）、股中肌（MVa）、股直肌下（SVa）和外侧髌旁（LPPa）入路对膝关节区域组织灌注的影响。
在这项实验研究中，总共对 28 只雌性兔子应用了四种不同的关节切开技术，分别为 MPPa 组、MVa 组、SVa 组和 LPPa 组。通过闪烁成像检查包括灌注储备和 T 扫描，对膝关节周围组织的血液供应进行了检查，3 周后，评估了氧化应激参数（包括丙二醛（MDA）、荧光氧化产物（FlOPs））的生化改变和组织学发现。
与健康的对侧膝关节相比，所有 4 组的灌注储备均增加。与 MPPa 组相比，LPPa 组的血管数量明显增加（p=0.006）。在生化参数检查中，与 LPPa 组相比，MPPa 组 MDA 水平升高具有统计学意义（p=0.004），与 LPPa 组相比，MVa 组 MDA 水平升高具有统计学意义（p=0.006）。与对照组相比，MPPa 组和 MVa 组 MDA 水平升高更为显著（p=0.004，p=0.004）。另一个氧化应激参数组织 FlOPs 水平的升高在 MPPa 组与对照组之间具有统计学意义（p=0.035）。
与 MPPa 和 MVa 相比，LPPa 和 SVa 在生化和闪烁成像参数方面引起的氧化应激和肌肉血液供应破坏更小。因此，在临床实践中，SVa 优于 MPPa 和 MVa 在全膝关节置换术中，在有临界软组织活力的特定情况下，LPPa 应更频繁地被选择。
