Sartawi Muthana, Rahman Hafizur, Kohlmann James, Leighton Ross, Kersh Mariana E
Department of Biomechanics, 6160 University Drive South, USA. Email:
Am J Orthop (Belle Mead NJ). 2018 Dec;47(12). doi: 10.12788/ajo.2018.0106.
The subvastus (SV) approach is a well-known muscle- and tendon-sparing approach for total knee arthroplasty (TKA), which has been shown in some studies to provide better outcomes in the visual analog pain score (VAS), knee range of motion (ROM), straight-leg raise, as well as faster rehabilitation, compared with the standard medial parapatellar (MP) approach. We previously described a new knee replacement technique known as the modified intervastus (MIV) approach. The MIV approach is a muscle- and tendon-sparing approach that is extensile and simple to perform. It may be used in the majority of complex primary cases and revisions. Here we describe the surgical technique for performing the MIV approach and provide functional outcome measures. A total of 127 patients (mean age, 66.75 years) underwent TKA using the MIV approach with 1-year follow-up. Clinical outcomes were assessed by recording both a VAS and knee ROM preoperatively, and again at several postoperative time points when the length of time required to ambulate independently (without assistive devices) was also measured. The VAS decreased significantly from the preoperative period (3.69 ± 2.22) to postoperative day 1 (3.17 ± 1.97) (P < .05). Although knee ROM decreased 1 week after surgery, the ROM increased by 6 weeks after surgery compared with the preoperative ROM, and the trend continued over the 1-year follow-up. One-third (33%) of patients were able to walk independently (without assistive devices) at 2 weeks and 78% at 8 weeks. The MIV approach to the knee is a muscle- and tendon-sparing approach that offers advantages over the SV approach and may be used for complex primary and revision total knee cases.
股直肌下（SV）入路是全膝关节置换术（TKA）中一种广为人知的保留肌肉和肌腱的入路，一些研究表明，与标准的髌旁内侧（MP）入路相比，该入路在视觉模拟疼痛评分（VAS）、膝关节活动范围（ROM）、直腿抬高以及更快康复方面能提供更好的结果。我们之前描述了一种新的膝关节置换技术，称为改良股中间肌（MIV）入路。MIV入路是一种保留肌肉和肌腱的入路，具有扩展性且操作简单。它可用于大多数复杂的初次病例和翻修手术。在此我们描述实施MIV入路的手术技术并提供功能结果指标。共有127例患者（平均年龄66.75岁）采用MIV入路进行TKA，并进行了1年的随访。通过术前记录VAS和膝关节ROM，并在术后几个时间点再次记录，同时测量独立行走（无需辅助装置）所需的时间，来评估临床结果。VAS从术前的（3.69±2.22）显著下降至术后第1天的（3.17±1.97）（P<.05）。虽然术后1周膝关节ROM下降，但与术前ROM相比，术后6周ROM增加，且在1年随访期间这一趋势持续。三分之一（33%）的患者在2周时能够独立行走（无需辅助装置），8周时为78%。膝关节的MIV入路是一种保留肌肉和肌腱的入路，与SV入路相比具有优势，可用于复杂的初次和翻修全膝关节病例。
