Tasker Andrew, Hassaballa Mohammed, Murray James, Lancaster Sarah, Artz Neil, Harries William, Porteous Andrew
Avon Orthopaedic Centre Bristol, United Kingdom.
Avon Orthopaedic Centre Bristol, United Kingdom.
Knee. 2014 Jan;21(1):189-93. doi: 10.1016/j.knee.2013.07.010. Epub 2013 Aug 2.
We present a prospective, randomised, multi-surgeon, controlled trial comparing minimally invasive (MIS) and standard approach total knee arthroplasty (TKA).
Participants underwent unilateral TKA. Patients were randomised to Bristol, quadriceps sparing MIS or standard medial parapatellar approaches. Length of stay with secondary outcome measures including knee range of movement, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Arthritis Index (WOMAC) and American Knee Society Score (KSS) up to 2 years. Radiographic and post operative assessment was blinded.
86 patients (92 knees) participated in the study. Mean operative time between MIS and control groups was 95.5 (95% CI 90.0-101.0) and 94.8 (95% CI 88.2-101.4) minutes respectively. Mean readiness for discharge was shorter in the MIS group 4.5±1.5 (95% CI, 4.1-4.9) days versus 5.9±2.7 (95% CI, 5.1-6.7) days amongst controls (p=0.004). Patients in the MIS group had fewer complications (p=0.003). One patient developed a deep vein thrombosis (DVT) and one required revision surgery, both in the control group. 83 patients completed follow up to 2 years (40 MIS, 43 controls). Range of movement and other outcome measures improved up to 1 year post-operatively with no statistically significant differences between MIS and controls. We found no evidence of radiographic loosening in either group at the 2 year follow up.
MIS offers reduced length of stay and fewer complications for patients following TKR without evidence of component mal-alignment. Our findings of fewer systemic complications in MIS TKR patients warrant further future study.
Level 1.
我们开展了一项前瞻性、随机、多外科医生参与的对照试验，比较微创（MIS）和标准入路全膝关节置换术（TKA）。
参与者接受单侧TKA。患者被随机分配至布里斯托、股四头肌保留MIS或标准内侧髌旁入路。记录住院时间以及包括膝关节活动范围、牛津膝关节评分（OKS）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）和美国膝关节协会评分（KSS）在内的次要结局指标，随访时间长达2年。影像学和术后评估采用盲法。
86例患者（92膝）参与了本研究。MIS组和对照组的平均手术时间分别为95.5（95%CI 90.0 - 101.0）分钟和94.8（95%CI 88.2 - 101.4）分钟。MIS组的平均出院准备时间更短，为4.5±1.5（95%CI，4.1 - 4.9）天，而对照组为5.9±2.7（95%CI，5.1 - 6.7）天（p = 0.004）。MIS组患者的并发症更少（p = 0.003）。对照组有1例患者发生深静脉血栓（DVT），1例需要翻修手术。83例患者完成了2年随访（40例MIS，43例对照）。术后1年内，两组的膝关节活动范围和其他结局指标均有所改善，MIS组和对照组之间无统计学显著差异。在2年随访时，两组均未发现影像学松动的证据。
对于接受TKR的患者，MIS可缩短住院时间并减少并发症，且无假体排列不良的证据。我们发现MIS TKR患者的全身并发症较少，这一发现值得未来进一步研究。
1级。
