摘要
背景:随着我国老龄化人口的增加,使患者术后达到加速康复的理念逐渐被外科医师接受。微创切口入路行全膝关节表面置换是否较标准入路具有临床优势,使患者达到加速康复仍存在争议。目的:通过临床对照研究微创切口与标准切口行全膝关节置换术后患者的近期临床效果和影像学结果。方法:选取2016年1月至2017年1月我院收治的重度骨关节炎患者70例,按手术方式不同,分为微创组和标准组,随访并比较两组各项临床指标、影像学指标、康复情况及术后并发症发生情况。结果:两组患者均完成随访。微创组手术切口长度、术后血红蛋白减少量、24 h引流量、术后股四头肌肌力恢复时间、术后第1天疼痛视觉模拟评分均优于标准组;两组术后7 d、6周、12周、6个月的膝关节活动度比较,差异有统计学意义(P<0.05);两组术后住院时间、手术操作时间,术后影像学评估指标比较,差异无统计学意义(P>0.05);两组均未发生严重的深静脉血栓、关节感染等并发症。结论:与标准切口入路比较,微创切口入路具有手术切口短、更美观,减少术后疼痛、引流量、血红蛋白下降值,更早恢复股四头肌肌力,提高患者膝关节活动度的优势,能使患者加速康复。
Background： With the increase of the aging population in China, the concept of enhanced recovery after surgery is gradually accepted by surgeons. However, whether minimally invasive approach for total knee arthroplasty has more clinical advantages than standard invasive approach and can help patients achieve enhanced recovery is still controversial. Objective： A controlled clinical study was conducted to compare the short-term clinical and radiogical outcomes of total knee arthroplasty using either standard or minimally invasive surgical approaches. Methods： A total of 70 patients with severe osteoarthritis of the knee admitted in our hospital from January 2016 to January 2017 were selected and divided into the minimally invasive group and standard invasive group according to the surgical procedures. Some clinical outcomes, post-operative radiological outcomes, recovery status and complications were evaluated between the two groups. Results： All patients completed the follow-up visits. Length of surgical incision, postoperative hemoglobin drop, postoperative 24 h drainage,postoperative Visual Analogue Scale score at the first day, and postoperative quadriceps muscle strength recovery time,and range of motion at 1 week, 6 weeks, 12 weeks and 6 months after operation were superior in minimally invasive group than in standard invasive group（P〈0.05）. There were no statistically significant differences in length of postoperative hospital stay, operation time or postoperative radiological indexes between the two groups（P〈0.05）. No patients had deep venous thrombosis and joint infection complications in both groups. Conclusions： Minimally invasive approach for total knee arthroplasty can effectively reduce surgical injury, postoperative pain, postoperative drainage and hemoglobin drop, and accelerate quadriceps muscle strength recovery and range of motion as compared with standard invasive approach, which helps patients achieve enhanced recovery.
作者
卢文龙
许建中
陈涛
田进翔
LU Wenlong;XU Jianzhong;CHEN Tao;TIAN Jinxiang(Department of Bone Joint and Sports Medicine, The First Affiliated Hospital of Zhengzhou Universit;Zhengzhou 450052, China)
出处
《中华骨与关节外科杂志》
2018年第3期161-165,共5页
Chinese Journal of Bone and Joint Surgery
关键词
全膝关节表面置换
微创切口
标准切口
临床对照研究
Total Knee Arthroplasty
Minimally Incision
Standard Incision
Clinical Controlled Study
