Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
Clin Orthop Relat Res. 2010 Jun;468(6):1635-48. doi: 10.1007/s11999-010-1285-9. Epub 2010 Mar 13.
Concerns have been raised regarding minimally invasive surgery (MIS) and its possible effect on postoperative functional recovery, complications, and survival rate after TKA.
QUESTIONS/PURPOSES: We specifically asked whether MIS TKA would be associated with (1) increased operative time, (2) reduced blood loss, (3) shortened hospital stay, (4) faster recovery of ROM, (5) higher knee scores, (6) inferior component positioning, and (7) increased complications.
We performed a systematic literature search of randomized controlled trials between minimally invasive and standard approaches in TKA that compared operative time, blood loss, ROM, knee scores, component positioning, and complications. We conducted a systematic review and meta-analysis of 13 trials published from 2007 to 2009 of MIS versus standard TKA.
Patients in the MIS group had longer operating times (10-19 minutes). Mean Knee Society scores were better after MIS than after the standard procedure at 6 and 12 weeks postoperatively, but not after 6 months. Improvement in ROM occurred more rapidly in the MIS group 6 days after TKA but later improvements are not clearly documented. We identified no differences between minimally invasive and standard approaches regarding the short-term overall complications and alignment of femoral and tibial components. However, wound healing problems and infections occurred more frequently in the MIS group.
MIS leads to faster recovery than conventional surgery with similar rates of component malalignment but is associated with more frequent delayed wound healing and infections. Potential benefits in long-term survival rate and functional improvement require additional investigation. Level of Evidence Level II, therapeutic study (systematic review). See the Guidelines for Authors for a complete description of levels of evidence.
人们对微创手术（MIS）及其对 TKA 后术后功能恢复、并发症和生存率的可能影响表示担忧。
问题/目的：我们特别询问了 MIS TKA 是否与以下方面有关：（1）手术时间增加，（2）出血量减少，（3）住院时间缩短，（4）ROM 更快恢复，（5）膝关节评分更高，（6）组件定位不佳，以及（7）并发症增加。
我们对 2007 年至 2009 年期间发表的关于 MIS 与标准 TKA 的比较手术时间、出血量、ROM、膝关节评分、组件定位和并发症的随机对照试验进行了系统文献检索。我们对 13 项研究进行了系统评价和荟萃分析，这些研究将 MIS 与标准 TKA 进行了比较。
MIS 组患者的手术时间较长（10-19 分钟）。MIS 组的 Knee Society 评分在术后 6 周和 12 周时优于标准组，但在 6 个月后则不然。MIS 组在 TKA 后 6 天 ROM 改善更快，但之后的改善情况则不明确。我们发现，在短期总体并发症和股骨及胫骨组件的对线方面，微创与标准方法之间没有差异。然而，MIS 组的伤口愈合问题和感染更为常见。
MIS 比传统手术更快地恢复，尽管组件对线不良的发生率相似，但与更频繁的延迟伤口愈合和感染有关。在长期生存率和功能改善方面的潜在益处需要进一步研究。证据等级 II，治疗研究（系统评价）。请参阅作者指南，以获取完整的证据等级描述。
