Bonutti Peter M, Zywiel Michael G, Ulrich Slif D, McGrath Mike S, Mont Michael A
Bonutti Clinic, Effingham, Illinois, USA.
Am J Orthop (Belle Mead NJ). 2010 Oct;39(10):480-4.
Despite reports of complications, there has been tremendous interest in using minimally invasive surgery (MIS) for total knee arthroplasty (TKA). Over the past 10 years, we have used an MIS approach for all TKAs. In the study described here, we examined the complications of the first 1000 of these TKAs. These cases involved a minimal incision (mean, 10 cm), a quadriceps muscle-sparing approach, and a non-patellar-everting technique. The complications assessed included manipulations, reoperations, and component revisions. We also analyzed for deviations in radiographic alignment or radiographic failures. There were 45 clinical complications-25 manipulations under anesthesia, 12 arthroscopic procedures for painful patellofemoral crepitus (mostly for an initially nonvisualized retained lateral band), and 8 operative explorations for various component problems. Radiographically, there were 3 impending component failures-2 tibial and 1 femoral. Excluding manipulations, there was a significant decrease in operative complication rate from the first 200 cases (6.0%) to the next 800 cases (1.0%), with overall complication rates similar to those of a control cohort treated with traditional surgical techniques. From this analysis, the major concern was potential tibial component loosening, which may be related to decreased exposure and possibly poor cement pressurization. Despite the low complication rate, this study yielded insights into further potential improvements in using this MIS technique for TKAs.
尽管有并发症的报道，但使用微创手术（MIS）进行全膝关节置换术（TKA）仍引起了极大的关注。在过去10年中，我们对所有全膝关节置换术都采用了微创方法。在本文所述的研究中，我们检查了其中前1000例全膝关节置换术的并发症。这些病例采用了最小切口（平均10厘米）、保留股四头肌的方法和不翻转髌骨的技术。评估的并发症包括手法操作、再次手术和假体翻修。我们还分析了影像学对线偏差或影像学失败情况。共有45例临床并发症——25例在麻醉下进行手法操作，12例因髌股关节疼痛性摩擦音而进行关节镜检查（主要针对最初未可视化的保留外侧束），8例因各种假体问题进行手术探查。在影像学方面，有3例假体即将出现失败——2例胫骨假体和1例股骨假体。排除手法操作后，前200例的手术并发症发生率（6.0%）与后800例（1.0%）相比有显著下降，总体并发症发生率与采用传统手术技术治疗的对照组相似。通过这项分析，主要担忧的是潜在的胫骨假体松动，这可能与暴露减少以及可能的骨水泥加压不足有关。尽管并发症发生率较低，但这项研究为进一步改进使用这种微创技术进行全膝关节置换术提供了见解。
