全膝關節置換術股內側肌入路與內側髕旁入路比較的系統評價_《中國循證醫學雜志》

作者：

1. 廣西醫科大學第一附屬醫院創傷骨科手外科（南寧 530021）；2. 四川大學華西醫院中國循證醫學中心（成都 610041）;

關鍵詞：

全膝關節置換術經股內側肌中間入路內側髕旁入路系統評價

DOI：

10.7507/1672-2531.20100453

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目的　系統評價經股內側肌入路全膝關節置換術的有效性及安全性。
方法　計算機檢索Cochrane 圖書館、EMbase、PubMed 和CBM，全面搜集經股內側肌入路和內側髕旁入路膝關節置換術的所有臨床對照試驗，按Cochrane 系統評價方法評價納入研究質量，并使用RevMan 5.0 軟件進行Meta 分析。
結果　最終納入8 個研究，包括4 個RCT，2 個半隨機對照試驗，2 個非隨機對照試驗。Mata 分析結果顯示，股內側肌入路組與內側髕旁組相比，外側支持帶松解率［RR=0.75，95%CI（0.52，1.08），P=0.12］、術后6 周膝關節屈曲活動度［MD=2.65，95%CI（– 1.20，6.50)，P=0.18）］、手術時間［MD=1.04，95%CI（– 3.50，5.58）］及術后不良反應［OR=1.04，95%CI（0.43，2.52），P=0.94］差異均無統計學意義。此外，1 個研究提示兩組術中出血量差異無統計學意義，2 個研究提示股內側肌入路組術中出血量要少于內側髕旁入路組，1 個研究未作統計學分析；2 個研究提示兩組術后直腿抬高時間上無差異，另1 個研究提示術后直腿抬高時間股內側肌入路組要短于內側髕旁入路組。
結論　現有證據表明，股內側肌入路全膝關節置換術在外側支持帶松解率、術后6 周膝關節屈曲活動度、手術時間和術后不良反應方面與內側髕旁入路的效果相似，但兩者術中出血量和直腿抬高時間有無差異尚不能判斷。受納入研究質量限制，上述結果還有待開展更多高質量的臨床試驗來進一步證實。

引用本文： 徐應龍,趙勁民,李書振,丁曉飛,吳泰相. 全膝關節置換術股內側肌入路與內側髕旁入路比較的系統評價. 中國循證醫學雜志, 2010, 10(5): 585-591. doi: 10.7507/1672-2531.20100453 復制

1.	Carol JD, Christine AL, Verita CB, et al. 2006 National Hospital Discharge Survey. National Health Statistics Report, 2008, July 30, Number 5.
2.	Heck DA, Robinson RL, Partridage CM, et al. Patient Outcomes after Knee Replacement. Clin Orthop Relat Res, 1998, 356: 93-l10．.
3.	Boyd AD, Ewald FC, Thomas WH, et al. Long-term complications after total knee arthroplasty with or without resurfacing of the patella. J Bone Joint Surg Am, 1993, 75: 674-681.
4.	Stuart MJ, Larson JE, Morrey BF. Reoperation after condylar revision total knee arthroplasty. Clin Orthop Relat Res, 1993, 286: 168-173.
5.	Aaron GR, Joshua JJ, Khaled GS, et al. The patella in revision total knee arthroplasty. J Bone Joint Surg Am, 2003, 85: 63-69.
6.	Lynch AF, Rorabeck CH, Bourne RB. Extensor mechanism complications following total knee arthroplasty, 1987, 2: 135-140.
7.	Hofmann AA, Plaster RL, Murdock LE. Subvastus (Southern) approach for primary total knee arthroplasty. Clin Orthop, 1991, 269: 70-77.
8.	Engh GA, Holt BT, Parks NL. A midvastus muscle-splitting approach for total knee arthroplasty. J Arthroplasty, 1997, 12: 322-331.
9.	Weinrauch P, Myers N, Wilkinson M, et al. Comparison of early postoperative rehabilitation outcome following total knee arthroplasty using different surgical approaches and instrumentation. The Journal of Orthopaedic Surgery (Hong Kong), 2006, 14(1): 47-52.
10.	Bassarir K, Erdemli B, Tuccar E, et al. Safe zone for the descending genicular artery in the midvastus approach to the knee. Clin Orthop Relat Res, 2006, 451: 96-100.
11.	Dalury DF, Jiranek WA. A comparison of the midvastus and paramedian approaches for total knee arthroplasty. J Arthroplasty, 1999, 14(1): 33-37.
12.	Higgins JPT, Altman DG (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 (updated February 2008). The Cochrane Collaboration, 2008. Available from www.cochrane-handbook.org.
13.	吳泰相, 劉關鍵. 隱蔽分組（分配隱藏）和盲法的概念、實施與報告. 中國循證醫學雜志, 2007, 7(3): 203-207.
14.	B?this H, Perlick L, Blum C, et al. Midvastus approach in total knee arthroplasty: a randomized, double-blinded study on early rehabilitation. Knee Surg Sports Traumatol Arthrosc, 2005, 13(7): 545-550.
15.	Fu PL, Li XH, Wu YL, et al. Comparison of midvastus and standard medial parapatellar approaches in total knee arthroplasty. Journal of Clinical Rehabilitative Tissue Engineering Research, 2008, 12(9): 1793-1796.
16.	Keating EM, Faris PM, et al. Comparison of the midvastus musclesplitting approach with the median parapatellar approach in total knee arthroplasty. J Arthroplasty, 1999, 14(1): 29-32.
17.	Kelly MJ, Rumi MN, Kothari M, et al. Comparison of the Vastus- Splitting and Median Parapatellar Approaches for Primary Total Knee Arthroplasty: A Prospective, Randomized Study. J Bone Joint Surg Am, 2006, 88(4): 715-720.
18.	Walter F, Haynes MB, Markel DC, et al. A randomized prospective study evaluating the effect of patellar eversion on the early functional outcomes in primary total knee arthroplasty. J Arthroplasty, 2007, 22(4): 509-514.
19.	White RE, Allman JK, Trauger JA, et al. Clinical comparison of the midvastus and medial parapatellar surgical approaches. Clin Orthop Relat Res, 1999, (367): 117-122.
20.	McMahon MS, Scudefi GR, Glashow JL, et al. Scintigraphic determination of patellar viability after excision of infrapatellar fat pad and/ or lateral retinacular release in total knee arthroplasty. Clin Orthop, 1990, (260): 10-l6.
21.	覃承珂, 裴國獻, 羅吉偉, 等. 全膝關節置換術中外側支持帶松解的指征. 中華創傷骨科雜志, 2006, 8(4): 396-397.
22.	Maestro A, Suarez MA, Rodriguez L, et al. The midvastus surgical approach in total knee arthroplasty. Int Orthop, 2000, 24(2): 104-107.

1. Carol JD, Christine AL, Verita CB, et al. 2006 National Hospital Discharge Survey. National Health Statistics Report, 2008, July 30, Number 5.
2. Heck DA, Robinson RL, Partridage CM, et al. Patient Outcomes after Knee Replacement. Clin Orthop Relat Res, 1998, 356: 93-l10．.
3. Boyd AD, Ewald FC, Thomas WH, et al. Long-term complications after total knee arthroplasty with or without resurfacing of the patella. J Bone Joint Surg Am, 1993, 75: 674-681.
4. Stuart MJ, Larson JE, Morrey BF. Reoperation after condylar revision total knee arthroplasty. Clin Orthop Relat Res, 1993, 286: 168-173.
5. Aaron GR, Joshua JJ, Khaled GS, et al. The patella in revision total knee arthroplasty. J Bone Joint Surg Am, 2003, 85: 63-69.
6. Lynch AF, Rorabeck CH, Bourne RB. Extensor mechanism complications following total knee arthroplasty, 1987, 2: 135-140.
7. Hofmann AA, Plaster RL, Murdock LE. Subvastus (Southern) approach for primary total knee arthroplasty. Clin Orthop, 1991, 269: 70-77.
8. Engh GA, Holt BT, Parks NL. A midvastus muscle-splitting approach for total knee arthroplasty. J Arthroplasty, 1997, 12: 322-331.
9. Weinrauch P, Myers N, Wilkinson M, et al. Comparison of early postoperative rehabilitation outcome following total knee arthroplasty using different surgical approaches and instrumentation. The Journal of Orthopaedic Surgery (Hong Kong), 2006, 14(1): 47-52.
10. Bassarir K, Erdemli B, Tuccar E, et al. Safe zone for the descending genicular artery in the midvastus approach to the knee. Clin Orthop Relat Res, 2006, 451: 96-100.
11. Dalury DF, Jiranek WA. A comparison of the midvastus and paramedian approaches for total knee arthroplasty. J Arthroplasty, 1999, 14(1): 33-37.
12. Higgins JPT, Altman DG (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 (updated February 2008). The Cochrane Collaboration, 2008. Available from www.cochrane-handbook.org.
13. 吳泰相, 劉關鍵. 隱蔽分組（分配隱藏）和盲法的概念、實施與報告. 中國循證醫學雜志, 2007, 7(3): 203-207.
14. B?this H, Perlick L, Blum C, et al. Midvastus approach in total knee arthroplasty: a randomized, double-blinded study on early rehabilitation. Knee Surg Sports Traumatol Arthrosc, 2005, 13(7): 545-550.
15. Fu PL, Li XH, Wu YL, et al. Comparison of midvastus and standard medial parapatellar approaches in total knee arthroplasty. Journal of Clinical Rehabilitative Tissue Engineering Research, 2008, 12(9): 1793-1796.
16. Keating EM, Faris PM, et al. Comparison of the midvastus musclesplitting approach with the median parapatellar approach in total knee arthroplasty. J Arthroplasty, 1999, 14(1): 29-32.
17. Kelly MJ, Rumi MN, Kothari M, et al. Comparison of the Vastus- Splitting and Median Parapatellar Approaches for Primary Total Knee Arthroplasty: A Prospective, Randomized Study. J Bone Joint Surg Am, 2006, 88(4): 715-720.
18. Walter F, Haynes MB, Markel DC, et al. A randomized prospective study evaluating the effect of patellar eversion on the early functional outcomes in primary total knee arthroplasty. J Arthroplasty, 2007, 22(4): 509-514.
19. White RE, Allman JK, Trauger JA, et al. Clinical comparison of the midvastus and medial parapatellar surgical approaches. Clin Orthop Relat Res, 1999, (367): 117-122.
20. McMahon MS, Scudefi GR, Glashow JL, et al. Scintigraphic determination of patellar viability after excision of infrapatellar fat pad and/ or lateral retinacular release in total knee arthroplasty. Clin Orthop, 1990, (260): 10-l6.
21. 覃承珂, 裴國獻, 羅吉偉, 等. 全膝關節置換術中外側支持帶松解的指征. 中華創傷骨科雜志, 2006, 8(4): 396-397.
22. Maestro A, Suarez MA, Rodriguez L, et al. The midvastus surgical approach in total knee arthroplasty. Int Orthop, 2000, 24(2): 104-107.

《中國循證醫學雜志》

全膝關節置換術股內側肌入路與內側髕旁入路比較的系統評價

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《中國循證醫學雜志》

全膝關節置換術股內側肌入路與內側髕旁入路比較的系統評價

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