微创与传统入路对全膝关节置换术后早期股四头肌肌力的影响

Influence to early postoperative quadriceps strength of minimally invasive and conventional approaches in total knee arthroplasty： a prospective randomized controlled

目的探讨微创与传统入路对全膝关节置换术后早期股四头肌肌力及膝关节功能的影响。方法选择2010年9月至2012年9月68例重度骨关节炎患者为研究对象，随机分为传统入路组和微创入路组，分别行传统髌旁内侧入路和微创髌旁内侧入路全膝关节置换术。两组患者年龄、体重指数、股四头肌肌力、伸膝迟滞角度、美国膝关节协会评分（American Knee Society Score，KSS）、西安大略和麦克马斯特大学（Western Ontario and McMaster Universities，WOMAC）骨关节炎指数、疼痛视觉模拟评分（visual analogue scale，VAS）的差异均无统计学意义。结果术后1、2、3、6、12个月微创入路组股四头肌肌力分别为（0．59±0．12）、（0．74±0．18）、（0．86±0．16）、（1．02±0．17）、（1．05±0．04）N·m／kg，传统人路组分别为（0．46±0．56）、（0．56±0．12）、（0．70±0．16）、（0．94±0．19）、（1．04±0．03）N·m／kg，差异有统计学意义；微创人路组伸膝迟滞角度分别为13．11°±6．56°、8．53°±5．12°、4．79°±3．62°、1．53°±2．64°、1．62°±1．76°，传统入路组分别为22．47°±8．41°、16．23°±6．26°、10．58°±4．4°、2．58°±2．85°、1．62°±1．76°，差异有统计学意义。微创入路组术后1、2个月KSS临床评分及功能评分更高，术后1个月WOMAC指数更低，术后第3天、第7天疼痛VAS评分更低。微创入路组2例出现切口浅表感染，经清创后完全愈合。两组各有1例发生小腿肌间静脉丛血栓形成，治疗后症状消失。均未发现假体对线不良、深部感染等并发症。结论与传统入路全膝关节置换术相比，微创入路手术对伸膝装置破坏更小，术后股四头肌肌力恢复更快，早期膝关节功能恢复更好。

Objective To compare the quadriceps strength and short-term outcome in patients who had undergone primary total knee arthroplasty （TKA） with minimally invasive （MIS） or conventional surgical technique. Methods Sixty-eight knees undergoing TKA were evaluated and they were randomly divided into two groups. One group included 34 knees which were undergone conventional approach, and the other group included 34 knees undergone MIS approach. The age, BMI, quadriceps strength, extension lag, American Knee Society Score （KSS）, Western Ontario and MeMaster Universities （WOMAC） osteoarthfitis index and visual analogue scale （VAS） of pain of all patients were evaluated at the day before surgery and the 1st, 2nd, 3rd, 6th, and 12th months after surgery. Results At the 1st, 2nd, 3rd, 6th, and 12th months after surgery, the quadriceps strength in MIS group was 0.59±0.12, 0.74±0.18, 0.86±0.16, 1.02±0.17, 1.05±0.04 N .m/kg respectively, while in conventional group was 0.46±0.56, 0.56±0.12, 0.70±0.16, 0.94±0.19, 1.04-±0.03 N·kg respectively. The extension lag in MIS group was 13.11°±6.56°, 8.53°± 5.12°, 4.79°±3.62°, 1.53°±2.64°, 1.62°±1.76° respectively, while in conventional group was 22.47°±8.41°,16.23°±6.26°, 10.58°±4.4°, 2.580±2.85°, 1.62°±1.76° respectively. There were significantly differences in the two groups. Meanwhile, compared with conventional patients, MIS patients demonstrated significantly higher KSS scores at the 1st and 2nd months postoperatively. WOMAC scores were significantly lower in MIS group than in conventional group at the 1st month after surgery. During the first postoperative week, MIS technique significantly decreased VAS scores, showing significance. On the other hand, no significant difference was observed with respect to deep infection incidence and radiological outcome between two groups. Conclusion MIS TKA offers a significant improvement in extensor muscle strength over conventional surgery. These results suggest that the MIS approach results in better outcomes with regard to maintaining extensor strength than the conventional surgical approach.