Ugbeye M E, Itakpe S E, Ayodabo O J
Arthroplasty Division, Department of Orthopaedics and Trauma, National Orthopaedic Hospital Igbobi, Lagos Nigeria.
West Afr J Med. 2018 Jan-Apr;35(1):15-19.
Total knee replacements are increasingly being carried out for the arthritic knee. This procedure is constantly being improved upon in order to improve outcome. There is currently no consensus of the best surgical approach for primary total knee arthroplasty. This study aims to test the hypothesis that the subvastus approach has significantly better early functional outcomes compared to the medial parapatellar approach.
Patients with bilateral knee arthritis who met the inclusion criteria were randomised into either the subvastus or medial parapatellar approach over a twelve month period. All patients had the same prosthesis inserted by one surgeon. Primary outcome measures were the Knee Society Score (KSS) at six (6) weeks post-operatively and evaluation of postoperative pain using the Visual Analogue Score (VAS) on the 2nd and 5th postoperative day. Secondary outcomes included blood loss and transfusion requirements.
Twenty-four knees recruited with 11 knees in the subvastus and 13 in the medial parapatellar group. Results showed a significantly lower postoperative pain in the subvastus group versus the medial parapatellar group (2.8 versus 4.62 p < 0.05). Transfusion requirements for subvastus group was half that needed for the medial parapatellar group; this however was not statistically significant. Evaluation of knee score at six weeks did not show any difference in outcome (80.8 versus 84.27 p > 0.05).
Post-operative pain is significantly reduced in the subvastus group, however short term knee function is not affected by surgical approach.
全膝关节置换术越来越多地应用于膝关节炎患者。该手术不断改进以提高疗效。目前对于初次全膝关节置换术的最佳手术入路尚无共识。本研究旨在验证以下假设：与髌旁内侧入路相比，股直肌下入路具有显著更好的早期功能结局。
符合纳入标准的双膝关节炎患者在12个月内被随机分为股直肌下入路组或髌旁内侧入路组。所有患者均由同一位外科医生植入相同的假体。主要结局指标为术后6周的膝关节协会评分（KSS）以及术后第2天和第5天使用视觉模拟评分法（VAS）评估术后疼痛。次要结局包括失血量和输血需求。
共纳入24例膝关节，股直肌下入路组11例，髌旁内侧入路组13例。结果显示，股直肌下入路组术后疼痛明显低于髌旁内侧入路组（2.8对4.62，p<0.05）。股直肌下入路组的输血需求量是髌旁内侧入路组的一半；然而，这一差异无统计学意义。术后6周膝关节评分评估结果未显示出任何差异（80.8对84.27，p>0.05）。
股直肌下入路组术后疼痛明显减轻，但手术入路不影响短期膝关节功能。
