Li Canfeng, Zeng Yi, Shen Bin, Kang Pengde, Yang Jing, Zhou Zongke, Pei Fuxing
Orthopedic Department, West China Hospital, Sichuan University, Chengdu, China.
Knee Surg Sports Traumatol Arthrosc. 2015 Jul;23(7):1971-85. doi: 10.1007/s00167-014-2837-4. Epub 2014 Jan 22.
Minimally invasive surgical (MIS) approaches for total knee arthroplasty (TKA) have become increasingly popular for doctors and patients. They have argued that it decreases post-operative pain, accelerates functional recovery and increases patient satisfaction due to less injury. However, critics are concerned about TKA's possible effects on component position and with complications, considering the procedure's limited exposure. The purpose of this study was to summarise the best evidence in comparing the clinical and radiological outcomes between MIS and a conventional approach in TKA.
Electronic databases were systematically searched to identify relevant randomised controlled trials (RCTs). Our search strategy followed the requirements of the Cochrane Library Handbook. Methodological quality was assessed, and data were extracted independently by two authors.
Thirty studies, including 2,536 TKAs, were reviewed: 1,259 minimally invasive and 1,277 conventional exposure TKAs. The results showed that while the MIS group had longer operation times and tourniquet times, it had superior outcomes in KSS (objective and total), range of motion, flexion range of motion, flexion 90° day, straight leg-raising day, total blood loss and decrease in haemoglobin. However, wound-healing problems occurred more frequently in the MIS group. There were no statistically significant differences in other clinical or radiological outcomes between the MIS and conventional groups in TKA.
The preliminary results indicate that the MIS approach provides an alternative to the conventional approach, with earlier rehabilitation but no malpositioning or severe complications. Wound-healing problems can be treated easily and effectively, and the risk also decreases as surgeons become more experienced, and more user-friendly instruments are invented. Potential benefits in medium- and long-term outcomes require larger, multicentre and well-conducted RCTs to confirm.
Therapeutic study, Level II.
全膝关节置换术（TKA）的微创外科（MIS）入路对于医生和患者而言越来越受欢迎。他们认为，由于损伤较小，该方法可减轻术后疼痛、加速功能恢复并提高患者满意度。然而，考虑到该手术暴露有限，批评者担心TKA对假体位置及并发症可能产生的影响。本研究的目的是总结对比TKA中MIS与传统入路的临床和影像学结果的最佳证据。
系统检索电子数据库以识别相关随机对照试验（RCT）。我们的检索策略遵循Cochrane图书馆手册的要求。评估方法学质量，数据由两位作者独立提取。
共纳入30项研究，包括2536例TKA：1259例微创暴露TKA和1277例传统暴露TKA。结果显示，虽然MIS组手术时间和止血带使用时间更长，但在膝关节协会评分（客观评分和总分）、活动范围、屈曲活动范围、术后90°屈曲日、直腿抬高日、总失血量和血红蛋白下降方面，MIS组效果更佳。然而，MIS组伤口愈合问题出现得更频繁。TKA的MIS组与传统组在其他临床或影像学结果上无统计学显著差异。
初步结果表明，MIS入路为传统入路提供了一种替代方案，康复更早，但无假体位置不当或严重并发症。伤口愈合问题易于有效处理，随着外科医生经验增加以及更方便使用的器械问世，风险也会降低。中长期结果的潜在益处需要更大规模、多中心且实施良好的RCT来证实。
治疗性研究，二级。
