Unnanuntana Aasis, Pornrattanamaneewong Chaturong, Mow Christopher S
Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 2012 Sep;95 Suppl 9:S29-35.
Although a minimally invasive total knee arthroplasty (MIS-TKA)fails to show superior short-term clinical results over a standard technique, the longer-term outcomes remain unknown.
Evaluate the intermediate clinical outcomes of MIS-TKA, comparing to those of standard technique.
The authors retrospectively collected data from the patients who underwent uncomplicated total knee arthroplasty between March 2004 and December 2005. Patients with a body mass index (BMI) over 30 kg/m2 or with severe deformity and those who required a complex surgical procedure were excluded. Patients were divided into 2 groups based on the surgical approach: 27patients (31 knees) and 26 patients (33 knees) for the MIS-TKA and standard TKA, respectively. Pre- and perioperative data were collected. Clinical and functional outcomes were followed-up to a minimum of 5 years.
The means follow-up in the MIS- and standard TKA groups were 73 and 74 months, respectively. Pre- and perioperative data did not show any differences between the two groups except for more females and lower BMI in the MIS-TKA group. At 2- and 5-year post-operative follow-up, the knee society pain and functional scores improved significantly in both groups (p < 0.001). There were no differences in the postoperative alignment, range of motion and the knee society scores between MIS- and standard TKA. In addition, post-operative complications were similar in both groups (2 manipulations under anesthesia and 1 traumatic rupture of patellar tendon in each group).
The present study showed that there were no differences in the intermediate-term post-operative function between MIS-TKA and standard TKA in a well-selected patient population. Thus, orthopedic surgeons should not compromise their surgical exposure by using small and unfamiliar surgical technique. Since MIS-technique may increase the postoperative complication rate, a long-term study to evaluate the results of MIS-TKA is still needed.
尽管微创全膝关节置换术（MIS-TKA）在短期临床效果上并不优于标准技术，但其长期疗效仍不明确。
评估MIS-TKA的中期临床疗效，并与标准技术的疗效进行比较。
作者回顾性收集了2004年3月至2005年12月期间接受单纯全膝关节置换术患者的数据。排除体重指数（BMI）超过30kg/m²、严重畸形或需要复杂手术的患者。根据手术方式将患者分为两组：MIS-TKA组27例（31膝），标准TKA组26例（33膝）。收集术前和围手术期数据。临床和功能结局随访至少5年。
MIS-TKA组和标准TKA组的平均随访时间分别为73个月和74个月。术前和围手术期数据显示，除MIS-TKA组女性更多、BMI更低外，两组之间没有任何差异。术后2年和5年随访时，两组的膝关节协会疼痛和功能评分均显著改善（p<0.001）。MIS-TKA组和标准TKA组在术后对线、活动范围和膝关节协会评分方面没有差异。此外，两组术后并发症相似（每组各有2例麻醉下手法操作和1例髌腱外伤性断裂）。
本研究表明，在精心挑选的患者群体中，MIS-TKA和标准TKA的中期术后功能没有差异。因此，骨科医生不应因采用小切口且不熟悉的手术技术而影响手术视野暴露。由于MIS技术可能会增加术后并发症发生率，仍需要进行长期研究以评估MIS-TKA的结果。
