目的 对比不同入路全膝关节置换术(TKA)治疗膝骨关节炎(KOA)的临床疗效。方法 选取2021年5月至2023年12月邢台医学高等专科学校第一附属医院拟接受TKA治疗的79例KOA患者为研究对象，随机数字表法分为A组(传统髌旁入路，39例)与B组(改良股肌下入路，40例)。比较两组下肢力线、膝关节功能、围术期指标;观察术后并发症发生情况。结果 B组术中出血量较A组少，术后首次下床活动时间较A组短[(338。76±12。37)ml比(364。84±11。63)ml，t=9。649，P＜0。05]，术后首次下床活动时间 B 组[(9。85±1。25)d]低于 A 组[(9。91±1。31)d，t=2。364，P＜0。05]。术后，两组Lysholm膝关节功能评分(LKS)上升，且B组[(71。17±4。38)分]高于A组[(68。24±4。62)分，t=2。893，P＜0。05];两组骨关节炎指数评分(WOMAC)下降，且B组[(41。36±4。72)分]低于A组[(45。62±4。63)分，t=4。012，P＜0。05]。术后，两组胫骨近端内侧角(MPTA)、股骨远端外侧角(LDFA)值均上升，且B组[(86。64±1。74)°、(87。82±0。84)°]高于A组[(85。14±2。14)°、(86。25±1。46)°，t=3。422、5。877，P＜0。05]。A 组术后并发症发生率(10。26％)与B组(7。5％)比较，差异无统计学意义(x2=0。001，P＞0。05)。结论 与传统髌旁入路比较，改良股肌下入路可减少TKA中出血量，缩短KOA患者术后下床活动时间，且更利于膝关节功能及下肢力线改善。
Clinical comparison of total knee arthroplasty with different approaches for knee osteoarthritis
Objective To compare the clinical efficacy of total knee arthroplasty(TKA)with dif-ferent approaches in the treatment of knee osteoarthritis(KOA).Methods A total of 79 KOA patients who received TKA treatment from May 2021 to December 2023 were selected as the study subjects,and were divided into group A(39 cases with traditional parapatellar approach)and group B(40 cases with im-proved subfemoral approach)by a random number table method.The lower limb force line,knee joint function and perioperative indexes of the two groups were compared.Postoperative complications were observed.Results The intraoperative blood loss in group B[(338.76±12.37)ml]was less than that in group A[(364.84±11.63)ml],and the first time of getting out of bed in group B[(9.85±1.25)d]was shorter than that in group A[(9.91±1.31)d,t=9.649,P＜0.05].After surgery,the Lysholm knee joint function score(LKS)increased in both groups,and that in group B[(71.17±4.38)points]was greater than in group A[(68.24±4.62)points,t=2.364 P＜0.05].Osteoarthritis index score(WOMAC)decreased in both groups,and that in group B[(41.36±4.72)points]was lower than in group A[(45.62±4.63)points,t=2.893,P＜0.05].After surgery,the values of proximal medial an-gle of tibia(MPTA)and distal lateral angle of femur(LDFA)increased in both groups,and those in group B[(86.64±1.74)°,(87.82±0.84)°]were greater than in group A[(85.14±2.14)°,(86.25±1.46)°,t=3.422,5.877,P＜0.05].There was no significant difference in the incidence of postopera-tive complications between group A(10.26％)and group B(7.5％,x2=0.001,P＞0.05).Conclusion Compared with the traditional parapatellar approach,the modified subfemoral approach can reduce the a-mount of blood loss in TKA,shorten the time of postoperative movement in KOA patients,and is more ben-eficial to the improvement of knee joint function and lower limb force line.
Knee osteoarthritisTotal knee arthroplastyKnee joint function
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