Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
J Arthroplasty. 2019 Dec;34(12):3004-3011.e1. doi: 10.1016/j.arth.2019.07.017. Epub 2019 Jul 15.
Quadriceps snips (QSs) are commonly used to gain enhanced exposure during revision total knee arthroplasties (TKAs). The goals of this study were to evaluate the longer-term clinical outcomes and complications in a contemporary cohort of patients treated with QS and to compare them to a matched cohort treated with standard exposure during revision TKAs.
We retrospectively identified 3107 revision TKAs performed at our institution between 2002 and 2012. QS was performed in 321 of these knees. Each QS revision TKA was 1:1 matched to a control (standard exposure) based on age, gender, body mass index, surgery date, and reason for revision. Clinical outcomes studied included Knee Society Score, range of motion, and extensor lag. Other outcomes assessed were complications (especially extensor mechanism disruption) and survivorship. Mean follow-up was 5 years.
The mean Knee Society Score improvement was not significantly different between groups (P = .9). At latest follow-up, the mean range of motion was 93° in the QS group and was slightly higher at 100° in the control group (P = .002). Postoperative extensor lag of 10 degrees or more was present in 21 (6.7%) QS knees versus 19 (6.8%) control knees (P = .95). Complication rates were similar in both groups with extensor mechanism disruption occurring in 3 in the QS group (0.7% at 10 years) versus 4 in the control group (0.8% at 10 years; P = .91). Kaplan-Meier survivorships free of revision for aseptic loosening, free of any revision, and free of any reoperation were similar at 10 years (85%, 71%, and 61%, respectively, in the QS group vs 89%, 70% and 60%, respectively, in the control group).
This matched cohort study is the largest to report the results of QS and also the largest to report results compared with patients treated with standard exposure. Building on the results of smaller historical series, this study demonstrates QS was a facile technique in complex revision TKAs allowing for safe exposure with few complications.
III (case-control study).
在翻修全膝关节置换术中，常使用四头肌切开术（QSs）来获得更好的显露。本研究的目的是评估在当代接受 QS 治疗的患者的长期临床结果和并发症，并将其与接受翻修全膝关节置换术标准显露治疗的匹配队列进行比较。
我们回顾性地确定了 2002 年至 2012 年在我们机构进行的 3107 例翻修全膝关节置换术。其中 321 例接受 QS。根据年龄、性别、体重指数、手术日期和翻修原因，将每例 QS 翻修全膝关节置换术与 1 例对照（标准显露）进行 1：1 匹配。研究的临床结果包括膝关节协会评分、活动范围和伸肌滞后。评估的其他结果包括并发症（特别是伸肌机制破坏）和存活率。平均随访 5 年。
两组间膝关节协会评分的改善无显著差异（P=0.9）。在末次随访时，QS 组的平均活动范围为 93°，而对照组稍高，为 100°（P=0.002）。术后伸肌滞后 10 度或以上的 QS 膝关节有 21 例（6.7%），对照组有 19 例（6.8%）（P=0.95）。两组并发症发生率相似，QS 组伸肌机制破坏 3 例（10 年时 0.7%），对照组 4 例（10 年时 0.8%）（P=0.91）。10 年时 QS 组无菌性松动、无任何翻修和无任何再手术的 Kaplan-Meier 存活率分别为 85%、71%和 61%，对照组分别为 89%、70%和 60%。
这项匹配队列研究是最大的报告 QS 结果的研究，也是最大的与接受标准显露治疗的患者进行结果比较的研究。基于较小的历史系列结果，本研究表明 QS 是一种在复杂翻修全膝关节置换术中简便的技术，可以安全地暴露，并发症少。
III（病例对照研究）。
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