Background Controversy still exists regarding whether medial parapatellar approach （MP） or midvastus approach （MV） is preferable in total knee arthroplasty （TKA） up to now.The aim of this meta-analysis was to co...Background Controversy still exists regarding whether medial parapatellar approach （MP） or midvastus approach （MV） is preferable in total knee arthroplasty （TKA） up to now.The aim of this meta-analysis was to compare the clinical and radiological outcomes following the MV or MP for TKA.Methods A comprehensive search of unrestricted-language literature of all studies comparing MP with MV was conducted through the electronic literature databases of PubMed,EMBASE,Cochrane Library,CNKI,VIP,and WANFANG.Retrieval time was from the time when databases were built to October 2013.Manual search of relevant trials,reviews,and related articles was also performed.Outcomes of interest included postoperative knee extensor and flexor function,postoperative pain,patella tilt,and complications.Relative risk （RR） and weighted mean differences （WMD） from each trial were pooled using random-effects or fixed-effects model depending on the heterogeneity of the included studies.A subgroup analysis or a sensitivity analysis was conducted to explore the potential source of heterogeneity when necessary.Results Twenty-one randomized controlled trials （RCTs） comprising 1 188 patients （1 450 knees） were eligible.Our results showed that MV was associated with better early postoperative extension （WMD=-1.26,95% CI-2.36 to-0.16,P=0.02） and flexion （WMD=10.13,95% CI 5.36 to 14.90,P 〈0.01）,less postoperative pain （WMD=-0.21,95% CI-0.34 to-0.07,P=0.002）,and no greater risk for complications than MP.The patella tilt did not differ significantly between the two groups （WMD=-0.70,95% CI-1.94 to 0.54,P=0.27）.Conclusions MV may be a better approach than MP,as it improves postoperative early joint function and decreases oain.Future multi-center randomized controlled studies with large sample sizes are required to verify the current findings.展开更多
目的比较膝关节半伸直位髌上入路与髌旁内侧入路髓内钉固定治疗胫骨多段骨折的临床疗效。方法回顾分析2018年7月—2022年12月收治且符合选择标准的43例采用髓内钉固定治疗的胫骨多段骨折患者临床资料,其中23例采用膝关节半伸直位髌上入...目的比较膝关节半伸直位髌上入路与髌旁内侧入路髓内钉固定治疗胫骨多段骨折的临床疗效。方法回顾分析2018年7月—2022年12月收治且符合选择标准的43例采用髓内钉固定治疗的胫骨多段骨折患者临床资料,其中23例采用膝关节半伸直位髌上入路(A组),20例采用膝关节半伸直位髌旁内侧入路(B组)。两组患者性别、年龄、致伤原因、受伤至手术时间、骨折国际内固定研究协会/美国骨创伤协会(AO/OTA)分型及术前疼痛视觉模拟评分(VAS)、膝关节活动度(range of motion,ROM)等基线资料比较差异均无统计学意义(P>0.05)。记录并比较两组患者手术时间、术中失血量、切口长度、术中透视次数及骨折愈合时间,统计两组术后4、8、12周膝关节VAS评分及ROM,观察术后并发症发生情况;末次随访时采用Lysholm评分评价膝关节功能。结果两组患者均顺利完成手术,术中无神经、血管损伤等并发症发生,术后所有切口均Ⅰ期愈合。两组手术时间、术中失血量、术中透视次数比较差异均无统计学意义(P>0.05);但B组手术切口长于A组,差异有统计学意义(P<0.05)。两组患者均获随访,随访时间12~30个月,平均21.1个月。术后随时间延长,两组膝关节VAS评分均逐渐降低,ROM逐渐增加,各时间点间差异均有统计学意义(P<0.05);术后4、8周B组VAS评分低于A组,差异有统计学意义(P<0.05),其余时间点两组间比较膝关节VAS评分及ROM差异均无统计学意义(P>0.05)。两组骨折均愈合,愈合时间比较差异无统计学意义(P>0.05)。随访期间无内固定物松动、断裂及骨折复位丢失等并发症发生。末次随访时,B组膝关节Lysholm评分显著优于A组,差异有统计学意义(P<0.05)。结论膝关节半伸直位髌上入路与髌旁内侧入路髓内钉固定治疗胫骨多段骨折均可获得满意疗效,髌旁内侧入路术后早期膝关节疼痛症状更轻,远期膝关节功能更优。展开更多
文摘Background Controversy still exists regarding whether medial parapatellar approach （MP） or midvastus approach （MV） is preferable in total knee arthroplasty （TKA） up to now.The aim of this meta-analysis was to compare the clinical and radiological outcomes following the MV or MP for TKA.Methods A comprehensive search of unrestricted-language literature of all studies comparing MP with MV was conducted through the electronic literature databases of PubMed,EMBASE,Cochrane Library,CNKI,VIP,and WANFANG.Retrieval time was from the time when databases were built to October 2013.Manual search of relevant trials,reviews,and related articles was also performed.Outcomes of interest included postoperative knee extensor and flexor function,postoperative pain,patella tilt,and complications.Relative risk （RR） and weighted mean differences （WMD） from each trial were pooled using random-effects or fixed-effects model depending on the heterogeneity of the included studies.A subgroup analysis or a sensitivity analysis was conducted to explore the potential source of heterogeneity when necessary.Results Twenty-one randomized controlled trials （RCTs） comprising 1 188 patients （1 450 knees） were eligible.Our results showed that MV was associated with better early postoperative extension （WMD=-1.26,95% CI-2.36 to-0.16,P=0.02） and flexion （WMD=10.13,95% CI 5.36 to 14.90,P 〈0.01）,less postoperative pain （WMD=-0.21,95% CI-0.34 to-0.07,P=0.002）,and no greater risk for complications than MP.The patella tilt did not differ significantly between the two groups （WMD=-0.70,95% CI-1.94 to 0.54,P=0.27）.Conclusions MV may be a better approach than MP,as it improves postoperative early joint function and decreases oain.Future multi-center randomized controlled studies with large sample sizes are required to verify the current findings.
文摘目的比较经股内侧肌入路与内侧髌旁入路行全膝关节置换术的临床疗效。方法 25例行同期双侧全膝关节置换术,每例患者随机一侧采用经股内侧肌入路,另一侧采用内侧髌旁入路,观察两组手术时间、术后引流量、术后6周关节活动度、直腿抬高恢复时间,术后第1、2、3、6天对每例患者双侧膝关节进行视觉模拟疼痛评分(visual analog scale,VAS)。结果经股内侧肌入路组在直腿抬高恢复时间[(2.2±0.8)d vs(4.4±1.4)d]、VAS评分方面明显优于内侧髌旁入路组(P<0.05),两组在术后引流量、手术时间、术后6周膝关节活动度方面差异无统计学意义(P>0.05)。结论经股内侧肌入路行全膝关节置换术与髌旁入路相比,可以减轻术后的疼痛,减少直腿抬高恢复时间,较早恢复膝关节功能,值得临床推广和应用。
文摘目的比较膝关节半伸直位髌上入路与髌旁内侧入路髓内钉固定治疗胫骨多段骨折的临床疗效。方法回顾分析2018年7月—2022年12月收治且符合选择标准的43例采用髓内钉固定治疗的胫骨多段骨折患者临床资料,其中23例采用膝关节半伸直位髌上入路(A组),20例采用膝关节半伸直位髌旁内侧入路(B组)。两组患者性别、年龄、致伤原因、受伤至手术时间、骨折国际内固定研究协会/美国骨创伤协会(AO/OTA)分型及术前疼痛视觉模拟评分(VAS)、膝关节活动度(range of motion,ROM)等基线资料比较差异均无统计学意义(P>0.05)。记录并比较两组患者手术时间、术中失血量、切口长度、术中透视次数及骨折愈合时间,统计两组术后4、8、12周膝关节VAS评分及ROM,观察术后并发症发生情况;末次随访时采用Lysholm评分评价膝关节功能。结果两组患者均顺利完成手术,术中无神经、血管损伤等并发症发生,术后所有切口均Ⅰ期愈合。两组手术时间、术中失血量、术中透视次数比较差异均无统计学意义(P>0.05);但B组手术切口长于A组,差异有统计学意义(P<0.05)。两组患者均获随访,随访时间12~30个月,平均21.1个月。术后随时间延长,两组膝关节VAS评分均逐渐降低,ROM逐渐增加,各时间点间差异均有统计学意义(P<0.05);术后4、8周B组VAS评分低于A组,差异有统计学意义(P<0.05),其余时间点两组间比较膝关节VAS评分及ROM差异均无统计学意义(P>0.05)。两组骨折均愈合,愈合时间比较差异无统计学意义(P>0.05)。随访期间无内固定物松动、断裂及骨折复位丢失等并发症发生。末次随访时,B组膝关节Lysholm评分显著优于A组,差异有统计学意义(P<0.05)。结论膝关节半伸直位髌上入路与髌旁内侧入路髓内钉固定治疗胫骨多段骨折均可获得满意疗效,髌旁内侧入路术后早期膝关节疼痛症状更轻,远期膝关节功能更优。
