Teng Yuanjun, Du Wenjia, Jiang Jin, Gao Xuren, Pan Shumei, Wang Jing, An Liping, Ma Jinglin, Xia Yayi
Orthopedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou City, Gansu Province, China.
Orthopedics. 2012 Dec;35(12):e1722-31. doi: 10.3928/01477447-20121120-16.
The subvastus and medial parapatellar approaches are 2 commonly performed techniques in total knee arthroplasty, but the optimal approach for total knee arthroplasty remains controversial. The purpose of this study was to compare the effectiveness and safety of the subvastus vs medial parapatellar approach.The PubMed, Embase, Cochrane Library, Inter-Services Intelligence Web of Knowledge, and Chinese Biomedical Literature databases were searched for eligible quasi-randomized, controlled and randomized, controlled trials. Two authors independently extracted data and assessed the methodological quality of the included studies according to the Cochrane handbook version 5.1.0. Statistical analysis was performed using Review Manager version 5.1 software. Eight randomized, controlled trials and 1 quasi-randomized, controlled trial involving 940 primary total knee arthroplasties were included for meta-analysis. Meta-analysis revealed significant differences favoring the subvastus group in Knee Society Score in terms of function at 4 to 6 weeks (weighted mean difference [WMD]=5.09; 95% confidence interval [CI], 3.08 to 7.09; P<.01) and knee score at 12 months (WMD=2.17; 95% CI, 0.01 to 4.34; P=.05) and lateral retinacular release (odds ratio=0.34; 95% CI, 0.14 to 0.79; P=.01) when compared with the medial parapatellar approach. However, both groups showed similar results in range of motion (P>.05), operative time (WMD=2.15; 95% CI, -3.61 to 7.35; P=.42), blood loss (WMD= -31.07; 95% CI, -91.89 to 29.75; P=.32), hospital stay (WMD= -0.18; 95% CI, -0.67 to 0.31; P=.47), and postoperative complications (P>.05).
股直肌下和髌旁内侧入路是全膝关节置换术中两种常用的技术，但全膝关节置换术的最佳入路仍存在争议。本研究的目的是比较股直肌下与髌旁内侧入路的有效性和安全性。检索了PubMed、Embase、Cochrane图书馆、服务间情报知识网和中国生物医学文献数据库，以查找符合条件的半随机对照试验和随机对照试验。两位作者独立提取数据，并根据Cochrane手册5.1.0版评估纳入研究的方法学质量。使用Review Manager 5.1软件进行统计分析。纳入八项随机对照试验和一项半随机对照试验，共940例初次全膝关节置换术进行荟萃分析。荟萃分析显示，与髌旁内侧入路相比，股直肌下组在4至6周时的膝关节协会功能评分（加权平均差[WMD]=5.09；95%置信区间[CI]，3.08至7.09；P<.01）、12个月时的膝关节评分（WMD=2.17；95%CI，0.01至4.34；P=.05）和外侧支持带松解（优势比=0.34；95%CI，0.14至0.79；P=.01）方面有显著差异。然而，两组在活动范围（P>.05）、手术时间（WMD=2.15；95%CI，-3.61至7.35；P=.42）、失血量（WMD=-31.07；95%CI，-91.89至29.75；P=.32）、住院时间（WMD=-0.18；95%CI，-0.67至0.31；P=.47）和术后并发症（P>.05）方面结果相似。
