全膝关节置换术中的微创与标准手术入路

Minimally invasive versus standard approach in total knee arthroplasty.

作者信息

Tashiro Yasutaka, Miura Hiromasa, Matsuda Shuichi, Okazaki Ken, Iwamoto Yukihide

机构信息

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.

出版信息

Clin Orthop Relat Res. 2007 Oct;463:144-50.

DOI:
Abstract

We compared a group of 20 patients who had 24 minimally invasive total knee arthroplasties with a similar group of 21 patients who had 25 standard medial parapatellar approach total knee arthroplasties. We wanted to clarify whether the minimally invasive group had an advantage over the standard group in muscle strength, pain level, postoperative recovery, and clinical results and whether the patients were prone to radiographically poor results, more operative time, and increased complications. The extensor and flexor torque, visual analog scale, pace of rehabilitation, Knee Society scores, radiographic findings, operative time, and complications of each group were examined. The minimally invasive group showed higher extensor torque values, higher ratios of postoperative to preoperative extensor torque, and lower average visual analog scale scores at 1 and 2 weeks. The patients in this group achieved straight leg raising, 90[degrees] knee flexion, and T-cane gait earlier. There was no component malalignment, but the tibial component shifted to a more medial position. The mean operative time was 56 minutes longer in the minimally invasive group. We encountered no major perioperative complications in either group. We believe the minimally invasive technique positively contributes to the early restoration of quadriceps strength and a speedy return to normal function.

摘要

我们将一组20例患者(共接受24例微创全膝关节置换术)与另一组21例患者(共接受25例标准内侧髌旁入路全膝关节置换术)进行了比较。我们想明确微创组在肌肉力量、疼痛程度、术后恢复及临床结果方面是否优于标准组,以及患者是否更容易出现影像学结果不佳、手术时间延长和并发症增加的情况。对每组的伸肌和屈肌扭矩、视觉模拟评分、康复进度、膝关节协会评分、影像学表现、手术时间及并发症进行了检查。微创组在术后1周和2周时显示出更高的伸肌扭矩值、更高的术后与术前伸肌扭矩比值以及更低的平均视觉模拟评分。该组患者实现直腿抬高、膝关节屈曲90度以及使用丁字拐行走的时间更早。未出现假体排列不齐,但胫骨假体向更内侧位置移位。微创组的平均手术时间长56分钟。两组均未出现重大围手术期并发症。我们认为微创技术对股四头肌力量的早期恢复及快速恢复正常功能有积极作用。

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