手术入路是否会影响全膝关节置换术患者的预后？
Does surgical approach affect patient outcomes of total knee arthroplasty?
机构信息
From the Department of Orthopaedic Surgery, Western University, London, Ont. (S. Sidhu, Somerville, A. Sidhu, Willing, Teeter, Lanting)
From the Department of Orthopaedic Surgery, Western University, London, Ont. (S. Sidhu, Somerville, A. Sidhu, Willing, Teeter, Lanting).
出版信息
Can J Surg. 2021 Oct;64(5):E521-E526. doi: 10.1503/cjs.010920.
BACKGROUND
Surgical approaches for total knee arthroplasty (TKA) include the medial parapatellar (MPA), subvastus (SV), midvastus (MV), and lateral parapatellar approach (LPA); it remains unclear which approach is superior.
METHODS
Patients having undergone TKA at our institution were retrospectively organized into matched groups according to surgical approach (MPA, MV, SV, or LPA). Outcomes between the groups were compared using the Short-Form 12 (SF-12), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS), and range of motion (ROM) up to 2 years postoperative.
RESULTS
Sixty-eight MV patients, 8 SV patients, and 4 LPA patients were matched with groups of MPA patients. There was no difference in outcomes between the MPA and MV groups up to 2 years. The SV group had significantly higher SF-12 Physical Composite Score (PCS; = 0.036) and WOMAC stiffness score ( = 0.014) at 2 years, but significantly lower flexion at 1 year ( = 0.022) than the MPA group. The LPA group had significantly lower SF-12 PCS ( = 0.011) and WOMAC function scores ( = 0.022) at 1 year than the MPA group.
CONCLUSION
There was no significant difference between the MPA and MV approach. The SV approach had some improved long-term outcomes over the MPA aproach (SF-12 and WOMAC), but had significantly lower flexion at 1 year. The LPA group showed inferior outcomes than the MPA group but had more severe valgus preoperative deformity ( = 0.024). Further studies are required to investigate the potential benefit of quadriceps-sparing approaches.
背景
全膝关节置换术（TKA）的手术入路包括内侧髌旁（MPA）、股中肌下入路（SV）、股中肌入路（MV）和外侧髌旁入路（LPA）；目前尚不清楚哪种方法更优。
方法
我们回顾性地将在我院接受 TKA 的患者根据手术入路（MPA、MV、SV 或 LPA）分为匹配组。使用简明健康状况量表 12 项（SF-12）、西部安大略省和麦克马斯特大学骨关节炎指数（WOMAC）、膝关节协会评分（KSS）和术后 2 年的关节活动度（ROM）比较组间的结果。
结果
68 例 MV 患者、8 例 SV 患者和 4 例 LPA 患者与 MPA 患者的匹配组进行了比较。在 2 年内，MPA 和 MV 组的结果没有差异。与 MPA 组相比，SV 组在 2 年时 SF-12 生理综合评分（PCS； = 0.036）和 WOMAC 僵硬评分（ = 0.014）更高，但在 1 年时膝关节屈曲度更低（ = 0.022）。与 MPA 组相比，LPA 组在 1 年时 SF-12 PCS（ = 0.011）和 WOMAC 功能评分（ = 0.022）更低。
结论
MPA 和 MV 入路之间没有显著差异。SV 入路在长期结果方面优于 MPA 入路（SF-12 和 WOMAC），但在 1 年时膝关节屈曲度明显降低。LPA 组的结果比 MPA 组差，但术前存在更严重的外翻畸形（ = 0.024）。需要进一步研究来探讨保留股四头肌的手术入路的潜在益处。
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