经股内侧肌入路全膝关节置换可降低置换后不良反应及加速膝关节功能恢复

文题释义：股内侧肌入路：以往全膝关节置换以内侧髌旁入路为主，创伤大、恢复慢，而经股内侧肌下入路更符合正常解剖，能完整保留伸膝装置。经股内侧肌入路被许多专家看好，因为这一入路对股四头肌内侧结构破坏较少，在后期功能恢复中占有优势，并且对于施术部位的破坏较少，容易恢复膝关节的本体感觉。 美国膝关节协会评分(KSS)：该评分由膝关节临床评分和功能评分两部分构成。膝关节临床评分包括患者对疼痛的主观感受、关节活动度、稳定性和缺陷扣分项，总分100分；功能评分包括行走能力、上下楼能力和功能缺陷扣分项，总分100分。规定：≥85分为优，70-84分为良，60-69分为可，低于60分为差。 背景：髌骨旁内侧入路已成为全膝关节置换的标准技术。然而，最近的研究报道了在使用经股内侧肌入路时功能恢复的优越结果。 目的：评估髌骨旁内侧入路和经股内侧肌入路2种手术技术的早期功能结果。 方法：研究为一项前瞻性随机双盲对照试验，50例全膝关节置换患者中男性和女性分别采用随机数字表法分为2组：股内侧肌入路组接受经股内侧肌入路方法；髌骨旁内侧入路组接受髌骨旁内侧入路，2组均使用相同类型的植入物。记录疼痛目测类比评分，并在术后3周和6周时评估治疗后活动范围、股四头肌强度及本体感觉。 结果与结论：①经股内侧肌入路组患者在休息和运动时疼痛明显低于髌骨旁内侧入路组；②经股内侧肌入路组平均股四头肌伸展强度显著优于髌骨旁内侧入路组；③经股内侧肌入路组患者术后本体感觉好于髌骨旁内侧入路组，而2组患者的运动范围相似；④结果说明，在早期康复期间，经股内侧肌入路方法比髌骨旁内侧入路更有优势，没有观察到与此方法相关的不良影响。 ORCID: 0000-0002-4332-9354(严贤科) 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Total knee arthroplasty through a midvastus approach reduces postoperative adverse reactions and accelerates functional recovery of the knee

BACKGROUND:Medial parapatellar approach has become the standard technique for total knee arthroplasty.However,recent studies have reported superior results in functional recovery using midvastus approach.OBJECTIVE:To evaluate the early functional outcomes of medial parapatellar and midvastus approaches.METHODS:This was a prospective,randomized,double-blind,and controlled trial.Fifty patients receiving total knee arthroplasty were randomized into two groups:medial parapatellar approach and midvastus approach.The same type of implants was used in both groups.The Visual Analogue Scale scores were recorded.The range of motion,quadriceps strength and proprioception were assessed at 3 and 6 weeks after surgery.RESULTS AND CONCLUSION:(1)The Visual Analogue Scale scores at rest and in active in the midvastus approach group were significantly lower than those in the medial parapatellar approach group.(2)The average quadriceps strength in the midvastus approach group was significantly better than that in the medial parapatellar approach group.(3)The postoperative quadriceps proprioception in the midvastus approach group was better than that in the medial parapatellar approach group.The range of motion was similar in both groups.(4)Therefore,during early rehabilitation,the midvastus approach is superior to the medial parapatellar approach,and no adverse effects associated with this method are observed.