全膝关节置换术中髌旁内外侧入路治疗中重度膝外翻畸形的疗效分析
Analysis of Therapeutic Effect of Medial and Lateral Parapatellar Approach in the Treatment of Moderate and Severe Valgus Deformity during Total Knee Arthroplasty

目的：分析全膝关节置换术中髌旁内、外侧入路治疗中重度膝关节外翻畸形的临床疗效。方法：选取利川市人民医院2018年1月~2022年12月收治行人工膝关节表面置换术治疗中重度膝关节外翻畸形患者60例为本次研究对象，其中骨关节炎36例，类风湿关节炎24例。根据患者手术方式分为内侧组28例、外侧组32例，内侧组采用髌旁内侧入路，外侧组采用髌旁外侧入路。分别比较2组一般基线资料、术中相关情况及末次随访膝关节功能等。结果：术前2组基线资料差异比较均无统计学意义(P > 0.05)，研究具有可比性；外侧组手术时间较内侧组手术时间更长，差异具有统计学意义(P < 0.05)；术后2组膝关节活动度差异比较无统计学意义(P > 0.05)；术后末次随访2组在HSS评分及WOMAC评分差异比较有统计学意义(P < 0.05)。结论：髌旁外侧入路在治疗中重度膝外翻畸形时可以取得较好的临床效果，与髌旁内侧入路相比，髌旁外侧入路在治疗中重度膝外翻畸形时，能更好地提供内侧软组织张力平衡、获得良好的髌骨轨迹、缩短手术时间；髌旁外侧入路长时间随访可获得更高的膝关节功能评分，经验丰富术者可作为治疗中重度膝外翻畸形手术入路首选。
Objective: To analyze the clinical effect of medial and lateral parapatellar approaches in the treatment of moderate and severe knee valgus deformity during total knee arthroplasty. Methods: Sixty patients with moderate and severe knee valvaration deformity treated by surface replacement of artificial knee joint from January 2018 to December 2022 in the Fourth Affiliated Hospital of Xinjiang Medical University were selected as the subjects of this study, including 36 cases of osteoarthritis and 24 cases of rheumatoid arthritis. Patients were divided into the internal test group (28 cases) and the lateral group (32 cases) according to the surgical method. The internal test group took the parapatellar medial approach and the lateral group took the parapatellar lateral approach. General baseline data, intraoperative relevant conditions and knee function at the last follow-up were compared between the two groups. Results: There was no significant difference in baseline data between the two groups before surgery (P > 0.05), and the studies were comparable. The operative time of the lateral group was longer than that of the medial group, and the difference was statistically significant (P < 0.05). There was no significant difference in knee motion between the two groups after surgery (P > 0.05). There were significant differences in HSS score and WOMAC score between the two groups at the last follow-up (P < 0.05). Conclusion: The lateral parapatellar approach can achieve better clinical results in the treatment of moderate and severe genu valva malformations. Compared with the medial parapatellar approach, the lateral parapatellar approach can provide better medial soft tissue tension balance, obtain good patellar trajectory, and shorten the operation time. Long-term follow-up of the lateral parapatellar approach can obtain higher knee functional scores, and