Huang Zeyu, Shen Bin, Ma Jun, Yang Jing, Zhou Zongke, Kang Pengde, Pei Fuxing
Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People’s Republic of China.
Orthopedics. 2012 Jul 1;35(7):e1038-45. doi: 10.3928/01477447-20120621-17.
The purpose of this prospective study was to analyze the biochemical markers of muscle damage and inflammation in patients treated with the mini-midvastus approach or the medial parapatellar approach for total knee arthroplasty. Of 60 patients who underwent unilateral total knee arthroplasty, 30 were treated with the mini-midvastus approach (MMV group) and 30 were treated with the medial parapatellar approach (MPP group). Serum creatine kinase, myoglobin, lactate dehydrogenase, glutamic oxaloacetic transaminase, C-reactive protein, interleukin-6, and interleukin-1β levels were measured preoperatively, immediately postoperatively (except for C-reactive protein level), and on postoperative days 1, 2, and 3. Student's t test, Pearson's chi-square test, and Fisher's exact test were used to compare the outcomes between the 2 groups. Compared with the MPP group, a significant increase in serum creatine kinase level existed in the MMV group on postoperative days 2 (P=.08) and 3 (P=.09) and cumulatively (P=.02). However, significantly elevated C-reactive protein and interleukin-6 levels existed in the MPP group.According to the serum creatine kinase levels, the mini-midvastus approach has no superiority over the medial parapatellar approach in terms of sparing muscle and may cause more muscle damage. Further study is warranted to determine the correlation between biochemical markers and functional deficits.
这项前瞻性研究的目的是分析采用小切口股中肌入路或髌旁内侧入路进行全膝关节置换术的患者的肌肉损伤和炎症生化标志物。在60例行单侧全膝关节置换术的患者中，30例采用小切口股中肌入路（MMV组），30例采用髌旁内侧入路（MPP组）。术前、术后即刻（C反应蛋白水平除外）以及术后第1、2和3天测量血清肌酸激酶、肌红蛋白、乳酸脱氢酶、谷草转氨酶、C反应蛋白、白细胞介素-6和白细胞介素-1β水平。采用学生t检验、Pearson卡方检验和Fisher精确检验比较两组的结果。与MPP组相比，MMV组术后第2天（P = 0.08）和第3天（P = 0.09）以及累积水平（P = 0.02）血清肌酸激酶水平显著升高。然而，MPP组C反应蛋白和白细胞介素-6水平显著升高。根据血清肌酸激酶水平，小切口股中肌入路在保留肌肉方面并不优于髌旁内侧入路，且可能导致更多肌肉损伤。有必要进一步研究以确定生化标志物与功能缺陷之间的相关性。
