Niki Yasuo, Mochizuki Takeshi, Momohara Shigeki, Saito Seiji, Toyama Yoshiaki, Matsumoto Hideo
Department of Orthopaedic Surgery, Keio University, Tokyo, Japan.
J Arthroplasty. 2009 Jun;24(4):499-504. doi: 10.1016/j.arth.2008.04.002. Epub 2008 Aug 30.
Minimization of soft-tissue damage is one of the primary purposes behind the application of minimally invasive surgery (MIS) in total knee arthroplasty (TKA). A consecutive series of 147 TKAs were enrolled in the present study, with 96 MIS-TKAs using 11 quadriceps-sparing, 46 subvastus, 32 midvastus, and 7 parapatellar approaches and 51 conventional TKAs using 22 subvastus, 9 midvastus, and 20 parapatellar approaches. Serum levels of creatinine phosphokinase, myoglobin, aldolase, lactate dehydrogenase, glutamic oxaloacetic transaminase, and creatinine were measured on postoperative days 0, 1, 2, 4, 7, and 14. Postoperative rising index (RI) was expressed as a proportion of the preoperative value. When RIs were compared between MIS-TKA and conventional TKA, no significant differences were found for any enzymes. Interestingly, the midvastus approach displayed the highest RIs for creatinine phosphokinase and myoglobin between the 4 vastus-splitting approaches. Consequently, degree of muscle damage was equivalent between MIS-TKA and conventional TKA, whereas types of vastus-splitting approach appeared closely related to muscle damage.
将软组织损伤降至最低是全膝关节置换术（TKA）中应用微创手术（MIS）的主要目的之一。本研究纳入了连续的147例TKA病例，其中96例MIS-TKA采用了11种股四头肌保留入路、46种股直肌下入路、32种股中间肌入路和7种髌旁入路，51例传统TKA采用了22种股直肌下入路、9种股中间肌入路和20种髌旁入路。在术后第0、1、2、4、7和14天测量血清肌酸磷酸激酶、肌红蛋白、醛缩酶、乳酸脱氢酶、谷草转氨酶和肌酐水平。术后上升指数（RI）表示为术前值的比例。当比较MIS-TKA和传统TKA之间的RI时，未发现任何酶有显著差异。有趣的是，在4种股直肌劈开入路中，股中间肌入路的肌酸磷酸激酶和肌红蛋白RI最高。因此，MIS-TKA和传统TKA之间的肌肉损伤程度相当，而股直肌劈开入路的类型似乎与肌肉损伤密切相关。
