Berstock James R, Murray James R, Whitehouse Michael R, Blom Ashley W, Beswick Andrew D
Musculoskeletal Research Unit, University of Bristol, UK.
Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK.
EFORT Open Rev. 2018 Mar 26;3(3):78-84. doi: 10.1302/2058-5241.3.170030. eCollection 2018 Mar.
Twenty randomized controlled trials comprising 1893 primary total knee replacements were included in this review.The subvastus approach conferred superior results for mean difference (MD) in time to regain an active straight leg raise (1.7 days, 95% confidence interval [CI] 1.0 to 2.3), visual analogue score for pain on day one (0.8 points on a scale out of 10, 95% CI 0.2 to 1.4) and total range of knee movement at one week (7°, 95% CI 3.2 to 10.7). The subvastus approach also resulted in fewer lateral releases (odds ratio 0.4, 95% CI 0.2 to 0.7) and less peri-operative blood loss (MD 57 mL, 95% CI 10.5 to 106.4) but prolonged surgical times (MD 9.7 min, 95% CI 3.9 to 15.6).There was no difference in Knee Society Score at six weeks or one year, or the rate of adverse events including superficial or deep infection, deep vein thrombosis or knee stiffness requiring manipulation under anaesthesia.This review demonstrates evidence of early post-operative benefits following the subvastus approach with equivalence between approaches thereafter. Cite this article: 2018;3:78-84. DOI: 10.1302/2058-5241.3.170030.
本综述纳入了20项随机对照试验，共1893例初次全膝关节置换术。股直肌下入路在恢复主动直腿抬高的平均时间差异（MD）方面（1.7天，95%置信区间[CI]为1.0至2.3）、术后第1天疼痛的视觉模拟评分（满分10分，为0.8分，95%CI为0.2至1.4）以及术后1周膝关节活动度的总范围（7°，95%CI为3.2至10.7）方面具有更优的结果。股直肌下入路还导致外侧松解术更少（优势比0.4，95%CI为0.2至0.7）以及围手术期失血量更少（MD 57 mL，95%CI为10.5至106.4），但手术时间延长（MD 9.7分钟，95%CI为3.9至15.6）。六周或一年时的膝关节协会评分，以及包括浅表或深部感染、深静脉血栓形成或需要在麻醉下手法治疗的膝关节僵硬在内的不良事件发生率没有差异。本综述证明了股直肌下入路术后早期具有益处，且此后两种入路疗效相当。引用本文：2018；3：78 - 84。DOI：10.1302/2058 - 5241.3.170030。
