微创全膝关节置换术的早期临床疗效分析

Minimally invasive total knee arthroplasty through a quadriceps sparing approach:a comparative study

目的比较不干扰股四头肌(QS)微创全膝置换术与标准全膝关节置换术的早期临床结果。方法 2005年3月至2006年3月,采用 QS 微创全膝置换术完成26例单侧全膝关节置换术(QS 组),观察切口长度、手术时间、出血量、关节屈曲活动度,视觉模拟(VAS)疼痛评分、膝关节协会评分(KSS)、下肢胫股角和直腿抬高时间等,并与同期33例标准髌旁内侧入路 TKA 比较(标准组)。结果术后平均随访17个月(12～23个月)。平均切口长度 QS 组为(9.5±1.5)cm,标准组为(14.0±2.3)cm(P<0.05)。止血带时间 QS 组为(83±16)min,标准组为(55±11)min(P<0.05)。平均胫股角 QS 组为外翻(5.7±1.5)°,标准组为(6.0±1.4)°(P>0.05)。VAS 评分术后1、3和7 dQS 组明显低于标准组,术后6周 VAS 评分无差异。膝关节主动屈曲活动度术后1周 QS 组可达到(107±12)°,标准组为(95±11)°(P<0.05),术后6周和3个月组间差异有统计学意义(P<0.05),术后12个月平均屈曲度组间差异无统计学意义(P>0.05)。直腿抬高术后1周 QS 组为23例(88%),而标准组为21例(64%)(P<0.05)。术后6周膝关节评分 QS 组为78±15,标准组为71±20(P<0.05)。QS 组1例出现有症状的深静脉血栓,标准组3例;QS 组1例伤口愈合不良。所有病例未发现深部感染,神经血管损伤等并发症。结论采用 QS 微创全膝置换,术后疼痛轻,有利于早期伸膝功能和活动度的恢复,但手术技术要求高,应严格掌握手术适应证。

Objective To evaluate the short term clinical results of minimally invasive total knee arthroplasty （MIS-TKA） through a quadriceps sparing （QS） approach compared with a standard TKA using a medial parapatellar exposure. Methods Between March 2005 and March 2006, 26 consecutive unilateral primary MIS-TKA through a QS approach were performed. It was compared that the short term clinical results of this group with an age-matched and sex-match cohort of total knee arthroplasty done with a standard medial parapatellar approach. Length of incision, tourniquet time, blood loss, flexion degree, visual analog scale （VAS） score, Knee Society score, tibiofemoral angle and the ability to do a straight leg raising maneuver were evaluated respectively. Results The mean follow-up time were 17 months （range 12-23 months）. The average length of incision was （9. 5 ± 1.5）cm in the QS group and （ 14. 0 ±2. 3）cm in the standard group （P 〈0. 05）. Average tourniquet times were （83 ± 16） minutes in the QS group and （55 ± 11 ） minutes for the standard group （ P 〈 0. 05 ）. Postoperative tibiofemoral angles averaged （ 5.7 ± 1.5 ）° valgus in the QS group knees and （6.0 ± 1.4）° valgns in the standard group knees （ P 〉 0. 05 ）. The average VAS scores were significantly lower at the first, the third and the seventh postoperative days in the QS group compared with that of the standard group, and the difference was not significant after 6 weeks between two groups. Mean flexion at one week was greater for the QS group （107 ± 12）° than that in the standard group （95 ± 11）°. Improved ROM also was seen 6 and 12 weeks postoperatively in the QS group with significant difference. There were no differences in ROM between the two groups in 12 months. The ability to straight leg raised at one week postoperatively was better in the QS group （23/26, 88% ） than that of the standard group（21/33, 64% ）. At the 6 weeks follow-up, the average knee score was （78 ± 15） points in the QS group and （71 ±20） points for the standard group （P〈0. 05）. Deep vein thrombosis were found in 1 case of the QS group and 3 cases for the standard group. One patient in the QS group developed superficial wound necrosis that healed uneventfully. There were no other complications such as deep infection, neurovascular injury and so on. Conclusions The MIS-TKA through a QS approach is associated with a more rapid functional recovery and improves range of motion. But higher specifications and more restrictive indications are of importance with the QS technique.