微创与传统全膝关节置换术早期疗效比较

EARLY POSTOPERATIVE CLINICAL EFFECT OF MINIMALLY INVASIVE VERSUS CONVENTIONAL TOTAL KNEE ARTHROPLASTY

目的比较微创与传统全膝关节置换术(TKA)的早期疗效。方法2018年9—12月,将需要行单侧TKA的90例膝骨关节炎(KOA)病人随机分为传统TKA组和微创TKA(MIS-TKA)组,各45例。比较两组病人手术相关指标,术后关节功能康复情况,不同时间点的静息和活动疼痛视觉模拟评分法(VAS)评分,炎症指标红细胞沉降率(ESR)、C-反应蛋白(CRP)水平,双侧膝关节皮温差及术后并发症发生情况。结果MIS-TKA组病人的切口长度小于传统TKA组,手术时间长于传统TKA组(t=13.856、8.203,P<0.001),但两组病人术中出血量差异无统计学意义(P>0.05)。MIS-TKA组病人的直腿抬高训练开始时间、首次下床活动时间、膝关节活动度及美国特种外科医院膝关节评分(HSS评分)均优于传统TKA组(t=-10.814~18.914,P<0.001)。术后2d,MISTKA组病人的静息VAS评分显著低于传统TKA组(F=3.143,P<0.05);术后1~4d,MIS-TKA组病人的活动VAS评分、CRP、ESR及双侧膝关节皮温差均低于传统TKA组(F=2.358~13.802,P<0.05)。两组病人术后均未发生感染、下肢深静脉血栓形成等并发症。结论MIS-TKA对病人创伤较小,可在一定程度上降低炎症反应,缓解疼痛,有利于提高病人膝关节活动度,促进关节功能恢复。

Objective To investigate the early postoperative clinical effect of minimally invasive surgery-total knee arthroplasty(MIS-TKA)versus conventional TKA.Methods From September to December in 2018,90 patients with knee osteoarthritis(KOA)who needed unilateral TKA were randomly divided into conventional TKA group and MIS-TKA group,with 45 patients in each group.The two groups were compared in terms of surgery-related conditions,postoperative rehabilitation of joint function,Visual Analogue Scale(VAS)scores of resting and active pain at different time points,inflammatory indicators(erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)),and skin temperature difference between bilateral knee joints,and the incidence rates of postoperative complications.Results Compared with the conventional TKA group,the MIS-TKA group had a significantly shorter incision length and a significantly longer time of operation(t=13.856,8.203;P<0.001),while there was no significant difference in intraoperative blood loss between the two groups(P>0.05).Compared with the conventional TKA group,the MIS-TKA group had significantly better starting time of straight leg elevation training,time to first ambulation,range of knee motion,and Hospital for Special Surgery knee rating score(t=-10.814 to 18.914,P<0.001).On day 2 after surgery,the MIS-TKA group had a significantly lower resting VAS score than the conventional TKA group(F=3.143,P<0.05),and compared with the conventional TKA group on days 1-4 after surgery,the MIS-TKA group had significantly lower active VAS score,CRP,ESR,and skin temperature difference between bilateral knee joints(F=2.358-13.802,P<0.05).No patient experienced the complications such as infection and deep venous thrombosis of the lower extremities.Conclusion MIS-TKA is less traumatic to patients and can reduce inflammatory response and alleviate pain to a certain extent,thereby helping to improve the range of knee motion and promote the recovery of joint function.