Escobar-Carrillo C, Maqueda-Quintanilla L, Arias-Arceo A X, Colín-Vázquez A, Rivera-Villa A H
Unidad Médica de Alta Especialidad (UMAE), Hospital de Traumatología y Ortopedia. «Dr. Victorio de la Fuente Narváez», Instituto Mexicano del Seguro Social (IMSS). Colector 15 s/n (Av. Fortuna), Col. Magdalena de las Salinas, Alcaldía. Gustavo A. Madero, CP 07760, Ciudad de México. México.
Servicio de Reemplazos Articulares. Unidad Médica de Alta Especialidad (UMAE), Hospital de Traumatología y Ortopedia. «Dr. Victorio de la Fuente Narváez», Instituto Mexicano del Seguro Social (IMSS). Colector 15 s/n (Av. Fortuna), Col. Magdalena de las Salinas, Alcaldía. Gustavo A. Madero, CP 07760, Ciudad de México. México.
Acta Ortop Mex. 2022 Jul-Aug;36(4):210-215.
total knee arthroplasty is a common procedure in orthopedic surgery for treating grade IV knee osteoarthritis. This procedure reduces pain and improves functionality. However, the results according to the approach are different, it is not clear which surgical approach is clearly superior. The objective of this study is to evaluate the time and post-surgical bleeding, as well as the postoperative pain of the midvasto versus medial parapatellar approach in primary total knee arthroplasty in grade IV gonarthrosis.
an observational, comparative, retrospective study was carried out from June 1, 2020 to December 31, 2020, including beneficiaries of the Mexican Social Security Institute over 18 years of age with a diagnosis of grade IV knee osteoarthritis scheduled for primary total knee arthroplasty in the absence of other inflammatory pathology, previous osteotomies or coagulopathies.
of 99 patients who underwent the midvasto approach (group M) and 100 patients to the medial parapatellar approach (group T), there was preoperative hemoglobin 14.7 g/l group M and 15.2 g/l group T, reduction was 5.0 g/l group M and 4.6 g/l group T. Significant pain reduction in both groups without significant difference; from 6.7 to 3.2 group M and from 6.7 to 3.1 group T. The surgical time was significantly longer with the medial parapatellar approach (98.7 versus 89.2 minutes).
both approaches represent an excellent access route to perform primary total knee arthroplasty; however, no significant differences were found in the volume of bleeding or in the reduction of pain, the midvaste approach was associated with shorter surgical time and less involvement of flexion of the knee. Therefore, the midvasto approach is recommended in patients undergoing primary total knee arthroplasty.
全膝关节置换术是骨科手术中治疗IV级膝关节骨关节炎的常见手术。该手术可减轻疼痛并改善功能。然而，根据手术入路的结果有所不同，目前尚不清楚哪种手术入路明显更具优势。本研究的目的是评估IV级膝关节病初次全膝关节置换术中，股中间肌入路与内侧髌旁入路的手术时间、术后出血情况以及术后疼痛。
2020年6月1日至2020年12月31日进行了一项观察性、对比性、回顾性研究，纳入了墨西哥社会保障局18岁以上、诊断为IV级膝关节骨关节炎、计划进行初次全膝关节置换术且无其他炎症性病变、既往无截骨术或凝血障碍的受益患者。
99例行股中间肌入路手术的患者（M组）和100例行内侧髌旁入路手术的患者（T组），术前血红蛋白M组为14.7 g/l，T组为15.2 g/l，术后降低量M组为5.0 g/l，T组为4.6 g/l。两组疼痛均显著减轻，无显著差异；M组从6.7降至3.2，T组从6.7降至3.1。内侧髌旁入路的手术时间显著更长（98.7分钟对89.2分钟）。
两种入路都是进行初次全膝关节置换术的良好途径；然而，在出血量或疼痛减轻方面未发现显著差异，股中间肌入路手术时间更短，对膝关节屈曲的影响更小。因此，建议在进行初次全膝关节置换术的患者中采用股中间肌入路。
