Department of Orthopedics, Semmelweis University, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Orthopedics, Uzsoki Street Hospital, Budapest, Hungary; Department of Traumatology, Semmelweis University, Budapest, Hungary.
J Arthroplasty. 2023 Dec;38(12):2750-2758. doi: 10.1016/j.arth.2023.06.004. Epub 2023 Jun 24.
Numerous surgical approaches are being used to perform total knee arthroplasty (TKA). This systematic review and network meta-analysis aimed to compare surgical approaches used in TKA regarding postoperative outcomesat different time points.
We performed a literature search from medical database inception until October 2, 2021. We searched for randomized controlled trials (RCTs) investigating patients undergoing TKA and comparing at least 2 surgical approaches regarding early postsurgical clinical outcomes (range of motion [ROM], pain on a visual analog scale, and Knee Society Score [KSS]). We included 33 RCTs in our networks. Using paired and network meta-analysis, we calculated pooled mean differences (MDs) with 95% CIs by comparing surgical approaches to the medial parapatellar method.
The subvastus (SV) method performed the best on days 1 (MD = 6.99; CI: 1.08; 12.89), 3 (MD = 8.00; CI: 2.08; 13.92), 4 (MD = 27.01; CI: 18.09; 35.92), and 6 (MD = 27.22; CI: 18.38; 36.07) for ROM improvement. Regarding the decrease in pain, the mini SV approach offered significantly lower pain values on days 1 (MD = -1.98; CI: -2.93; -1.03), 3 (MD = -0.85; CI: -1.49; -0.22), and 7 (MD = -1.90; CI: -2.23; -1.57). The differences decreased as time passed. Furthermore, the SV and mini-SV methods performed the best regarding total, knee and function KSS.
Quadriceps-sparing approaches, especially the SV and mini-SV, are superior to the other approaches in the early postsurgical period, but the differences decrease as time passes.
目前有许多手术方法被用于全膝关节置换术（TKA）。本系统评价和网络荟萃分析旨在比较 TKA 中不同手术入路在不同时间点的术后结果。
我们从医学数据库创建开始到 2021 年 10 月 2 日进行了文献检索。我们检索了比较至少两种手术入路的随机对照试验（RCT），以评估早期术后临床结果（关节活动度[ROM]、视觉模拟评分疼痛和膝关节协会评分[KSS]）。我们将 33 项 RCT 纳入网络。使用配对和网络荟萃分析，我们通过比较手术入路与内侧髌旁入路来计算汇总平均差值（MD）及其 95%置信区间。
SV 方法在第 1 天（MD=6.99；CI：1.08；12.89）、第 3 天（MD=8.00；CI：2.08；13.92）、第 4 天（MD=27.01；CI：18.09；35.92）和第 6 天（MD=27.22；CI：18.38；36.07）时 ROM 改善效果最佳。关于疼痛减轻，微创 SV 方法在第 1 天（MD=-1.98；CI：-2.93；-1.03）、第 3 天（MD=-0.85；CI：-1.49；-0.22）和第 7 天（MD=-1.90；CI：-2.23；-1.57）时疼痛值显著降低。随着时间的推移，差异逐渐减小。此外，SV 和迷你-SV 方法在总、膝和功能 KSS 方面表现最佳。
股四头肌保留方法，尤其是 SV 和迷你-SV，在术后早期优于其他方法，但随着时间的推移，差异会减小。
