髌旁内侧入路与股外侧肌下入路支持快速康复全膝关节置换术的比较：系统评价和网络荟萃分析。

Subvastus Approach Supporting Fast-Track Total Knee Arthroplasty Over the Medial Parapatellar Approach: A Systematic Review and Network Meta-Analysis.

机构信息

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.

出版信息

J Arthroplasty. 2023 Dec;38(12):2750-2758. doi: 10.1016/j.arth.2023.06.004. Epub 2023 Jun 24.

DOI:10.1016/j.arth.2023.06.004

PMID:37356465

Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

摘要

背景

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。

方法

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。

结果

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。