Shin Young-Soo, Kim Hyun-Jung, Ko Young-Rok, Yoon Jung-Ro
Department of Orthopedic Surgery, Veterans Health Service Medical Center, 61 Jinhwangdoro-gil, Gangdong-Gu, Seoul, 134-791, South Korea.
Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea.
Knee Surg Sports Traumatol Arthrosc. 2016 Nov;24(11):3425-3432. doi: 10.1007/s00167-016-4016-2. Epub 2016 Feb 9.
It is unclear whether the minimally invasive navigation-assisted (MINA) or conventional (CONv) approach for primary total knee arthroplasty (TKA) leads to better clinical and radiographic outcomes. This meta-analysis compared the clinical and radiographic outcomes of the MINA and CONv approaches after primary TKA. It was hypothesized that there was no difference in clinical and radiographic outcomes between the two surgical approaches for primary TKA.
This meta-analysis reviewed all studies that compared surgical time, incision length, flexion range of motion (ROM), Knee Society Score ( KSS), coronal mechanical axis (CMA), and coronal femoral component angle (CFCA) with various measurement tools, from direct interview to plain radiography, between the MINA and CONv approaches.
Five studies met the inclusion/exclusion criteria for the meta-analysis. The findings of this study suggest that surgical time (95 % CI -18.51 to 39.09; n.s.), KSS (95 % CI -8.55 to 30.84; n.s.), CMA (95 % CI -1.01 to 0.54; n.s.), and CFCA (95 % CI -0.91 to 2.97; n.s.) were similar between the two surgical approaches, whereas incision length (95 % CI -5.18 to -3.69; P < 0.001) was significantly shorter in the MINA approach and flexion ROM (95 % CI 14.26-19.01; P < 0.001) was significantly greater in the MINA approach.
There were no significant differences in clinical and radiographic outcomes, including surgical time, KSS, CMA, and CFCA, in patients who underwent MINA and CONv approach for primary TKA, but the MINA approach resulted in a slightly shorter incision length and increased flexion ROM than the CONv approach. Therefore, if particular attention has to be paid to patient's selection with appropriate counselling and surgeon's experience, MINA approach can provide early clinical benefit when compared with CONv approach. Besides, orthopaedic surgeons need to master the MINA and CONv approaches because both approaches have similar clinical and radiographic outcomes.
Therapeutic study, Level II.
对于初次全膝关节置换术（TKA），微创导航辅助（MINA）或传统（CONv）手术方式是否能带来更好的临床和影像学结果尚不清楚。本荟萃分析比较了初次TKA后MINA和CONv手术方式的临床和影像学结果。研究假设是，两种初次TKA手术方式在临床和影像学结果上没有差异。
本荟萃分析回顾了所有比较MINA和CONv手术方式的研究，这些研究使用了从直接访谈到普通X线摄影等各种测量工具，比较了手术时间、切口长度、屈曲活动范围（ROM）、膝关节协会评分（KSS）、冠状面机械轴（CMA）和冠状面股骨组件角度（CFCA）。
五项研究符合荟萃分析的纳入/排除标准。本研究结果表明，两种手术方式在手术时间（95%CI -18.51至39.09；无统计学意义）、KSS（95%CI -8.55至30.84；无统计学意义）、CMA（95%CI -1.01至0.54；无统计学意义）和CFCA（95%CI -0.91至2.97；无统计学意义）方面相似，而MINA手术方式的切口长度明显更短（95%CI -5.18至-3.69；P < 0.001），且MINA手术方式的屈曲ROM明显更大（95%CI 14.26 - 19.01；P < 0.001）。
接受初次TKA的MINA和CONv手术方式患者在临床和影像学结果方面，包括手术时间、KSS、CMA和CFCA，没有显著差异，但MINA手术方式的切口长度略短，屈曲ROM比CONv手术方式更大。因此，如果在患者选择时给予适当的咨询并考虑外科医生的经验，与CONv手术方式相比，MINA手术方式可提供早期临床益处。此外，骨科医生需要掌握MINA和CONv手术方式，因为两种方式具有相似的临床和影像学结果。
治疗性研究，二级。
