Tenholder Mark, Clarke Henry D, Scuderi Giles R
Orthopaedic Associates, Fort Walton Beach, FL, USA.
Clin Orthop Relat Res. 2005 Nov;440:67-76. doi: 10.1097/01.blo.0000185450.89364.10.
Minimal-incision total knee arthroplasty can be considered part of the continuum from traditional extensile exposures to the quadriceps-sparing approach. We did this study to identify preoperative variables that predict which patients are amenable to a mini-incision and mini-arthrotomy technique, and to compare early outcomes in these patients versus patients in whom a standard approach was required. A consecutive series of 118 primary total knee arthroplasties were evaluated. In each case, the incision and arthrotomy were kept as small as possible, while still allowing proper implantation of the prosthesis. Group 1 consisted of 69 patients (58%) with skin incisions smaller than 14 cm and limited medial parapatellar arthrotomies. Group 2 consisted of 49 patients (42%) with incisions greater than or equal to 14 cm and standard medial parapatellar arthrotomies. Patients in Group 1 averaged one size smaller femoral and tibial components, had narrower femurs, required fewer transfusions and had better postoperative flexion. There were no differences between the groups in length of hospital stay, ambulatory ability, stair-climbing, tourniquet time, radiographic alignment, or complications. Based on these results, the ideal patient for a minimal incision total knee arthroplasty and limited arthrotomy seems to be a thin woman with a low body mass index, a narrow femur, and good preoperative range of motion.
Prognostic study, Level III-1 (retrospective cohort study). See the Guidelines for Authors for a complete description of levels of evidence.
微创全膝关节置换术可被视为从传统的广泛暴露到保留股四头肌入路这一连续过程的一部分。我们开展这项研究以确定术前变量，这些变量可预测哪些患者适合采用小切口和小关节切开技术，并比较这些患者与需要采用标准入路的患者的早期结局。对连续的118例初次全膝关节置换术进行了评估。在每例手术中，切口和关节切开均尽可能小，同时仍能确保假体的正确植入。第1组由69例患者（58%）组成，其皮肤切口小于14 cm，采用有限的内侧髌旁关节切开术。第2组由49例患者（42%）组成，其切口大于或等于14 cm，采用标准的内侧髌旁关节切开术。第1组患者的股骨和胫骨假体平均尺寸小一号，股骨更窄，输血需求更少，术后屈曲更好。两组在住院时间、行走能力、爬楼梯能力、止血带使用时间、影像学对线或并发症方面无差异。基于这些结果，微创全膝关节置换术和有限关节切开术的理想患者似乎是体重指数低、股骨窄且术前活动范围良好的瘦女性。
预后研究，III-1级（回顾性队列研究）。有关证据水平的完整描述，请参阅作者指南。
