INTRODUCTION: A key factor in minimally invasive knee surgery is protecting and preserving muscles. The muscles provide strength and control of our knee range of motion. The muscles are also an important factor in regaining motion. As one would expect, not cutting or detaching muscles around the knee results in less pain, better motion and faster recovery as in Subvastus approach of TKR. This study is Randomized prospective observational study, in which few signicant patient factor like :- FFD, BMI, Insall-Salvati score, muscle to bone ratio and varus valgus deformity got studied with respect to the Exposure level achieved by surgeon during knee replacement operation via Subvastus approach. This study in near future would help surgeons to decide whether a particular patient for knee replacement can be considered for surgery via Subvastus approach ,which is superior in terms of postop – rehabilitation and pain score than conventional approaches. 60 MATERIALS AND METHODS: patients with difculty in walking or pain in knee, requiring replacement are taken in this study from January 2019 to December 2019. DISCUSSION: The study shows that the exposure level for the surgeons gets restricted when the patient is Obese, muscularand one having xed exion deformity of his knee. Recurvatum on the other hand positively related to exposure level , which means patient with knee recurvatum had better exposure level in Tkr via Subvastus approach. Subvastus approach for Total knee re CONCLUSION: placement has benets of early postop recovery and better patient compliance but greater surgical skills of operating surgeon required because of reduced exposure level in surgery and muscle bulk is preserved.
(Fuber et al., 1975) We have now applied Maybury's criterion (Maybury et al., 1977) Patients and methodsBetween September 1971 and February 1977, 98 duodenal ulcerpatients had either a proximal gastric vagotomy (46 cases) or a proximal gastric vagotomy combined with a rotational posterior gastropexy (52 cases). Randomization was not carried out because 28 patients with grade 3 oesophageal reflux symptoms had a PGV and gastropexy while only 5 such cases had a PGV alone. Also the PGV series was started 5 months earlier than the PGV and gastropexy series. However, the two groups matched well in respect of age, sex, weight and symptoms.Despite non-randomization, we think the results of the two operations can be fairly compared. It might be argued that the first 10 or so operations constituted a 'learning period' during which vagotomy might be expected to be incomplete. In fact, on insulin testing at 1 year or more postoperatively, only 1 of the first 9 PGV patients (completed before the PGV and gastropexy series was started) was Faber positive (Faber et al., 1975). This compares with 9 Faber positives out of a total of 31 tests carried out in males after PGV. If the runs test for randomness is applied to the Faber positives they are found to be evenly scattered through the group of male PGV insulin tests. Similarly, the runs test shows an even scatter of Maybury positives (Maybury et al., 1977) through the whole group of insulin tests carried out after both PGV and PGV and gastropexy in both males and females. In this respect the series is not non-random.One of us (D. M. H.), who carried out most of the operations, was taught the technique of highly selective vagotomy (HSV) or proximal gastric vagotomy by Professor David Johnston before commencing this work. By this procedure the body, fundus, cardia and lower 4-5 cm of oesophagus are denervated, preserving the nerves of Latarjet to the antrum up to 6-7 crn from the pylorus.In PGV and rotational posterior gastropexy the raw areas that have been dissected in PGV are rotated away from each other by suturing the strong sling fibres of Willis at midanterior gastro-oesophageal junction level to the tough pre-aortic fascia. Two or three good sutures leave the oesophagus under slight tension with the fundus rolled up over its front. At this stage a no. 38-40 stomach tube should pass from the oesophagus into the stomach without let o r hindrance. With the large tube in place the anterior fundoplication (which has formed automatically if the pre-aortic fascia sutures have been correctly inserted) is fixed in place by two to three more sutures between the anterior stomach wall and the oesophagus. The gastro-oesophageal fat pad must be excised as the first step after completion of PGV in order to demonstrate the sling fibres of Willis. This procedure produces an intraabdominal segment of oesophagus witha flapvalve at the gastrooesophageal junction. It also separates nerve twigs (cut during PGV) by traction and rotation at gastro-oesophageal level and rotation at lesser cu...
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