Yuan Fu-Zhen, Zhang Ji-Ying, Jiang Dong, Yu Jia-Kuo
Institution of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, 100191, China.
BMC Musculoskelet Disord. 2019 Mar 20;20(1):117. doi: 10.1186/s12891-019-2482-7.
There is still controversy regarding whether Quadriceps-sparing (QS) approach for total knee arthroplasty (TKA) lead to better earlier recovery as well as compromising low limb alignment and prosthesis position compared with conventional medial parapatellar (MP) approach. To overcome the shortcomings and inaccuracies of single studies, the clinical outcomes and radiographic assessments of QS approach and MP approach were evaluated through meta-analysis.
We performed this meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. A literature search was conducted in the PubMed, EMBase, Cochrane Collaboration Library and Web of Science databases. Our search strategy followed the requirements of the Cochrane Library Handbook. The study selection, data extraction and assessment of methodological quality were independently completed by four authors. And subgroup analysis and publication bias were also performed in the study.
Eight prospective randomized controlled trials (RCTs) and eight retrospective studies were identified. Overall meta-analysis and subgroup meta-analysis of RCTs identified the QS approach mainly was associated with increased Knee Society function score beyond 24 months postoperatively (weighted mean difference [WMD] 1.78, P = 0.0004) (WMD 1.86, P = 0.0002), and improved range of motion 1-2 weeks postoperatively (WMD 5.84, P < 0.00001) (WMD 4.87, P = 0.002). Besides, lower visual analogue scale on postoperative day 1 (WMD -0.91, P = 0.02), shorter hospital stay (WMD -0.88, P = 0.02) and shorter incision (extension) (WMD -4.62, P < 0.00001) were indicated in overall meta-analysis. However, surgical and tourniquet time was significantly longer in QS group by both overall and subgroup meta-analysis.
QS approach may accelerate early recovery without increasing the risk of malalignment of low limb and malposition of prosthesis.
对于全膝关节置换术（TKA）中保留股四头肌（QS）入路与传统内侧髌旁（MP）入路相比，是否能带来更好的早期恢复，同时又不影响下肢对线和假体位置，仍存在争议。为了克服单个研究的缺点和不准确之处，通过荟萃分析评估了QS入路和MP入路的临床结果和影像学评估。
我们根据系统评价和荟萃分析的首选报告项目指南进行了这项荟萃分析。在PubMed、EMBase、Cochrane协作图书馆和科学网数据库中进行了文献检索。我们的检索策略遵循Cochrane图书馆手册的要求。研究选择、数据提取和方法学质量评估由四位作者独立完成。研究中还进行了亚组分析和发表偏倚分析。
共纳入八项前瞻性随机对照试验（RCT）和八项回顾性研究。RCT的总体荟萃分析和亚组荟萃分析表明，QS入路主要与术后24个月以上膝关节协会功能评分增加相关（加权平均差[WMD]1.78，P = 0.0004）（WMD 1.86，P = 0.0002），以及术后1-2周活动范围改善（WMD 5.84，P < 0.00001）（WMD 4.87，P = 0.002）。此外，总体荟萃分析显示术后第1天视觉模拟评分较低（WMD -0.91，P = 0.02）、住院时间较短（WMD -0.88，P = 0.02）和切口（延长）较短（WMD -4.62，P < 0.00001）。然而，总体和亚组荟萃分析均显示QS组的手术时间和止血带时间明显更长。
QS入路可能加速早期恢复，而不会增加下肢对线不良和假体位置不当的风险。
