PDF(Pubmed)
Abstract：
The aim of the study was to assess the efficiency of a developed minimally invasive (epivastus) approach in total knee arthroplasty (TKA) by comparing its early results with those of a standard medial mediapatellar approach (MMPA).
UNASSIGNED: A single-center, comparative randomized prospective study involved 127 patients, who underwent TKA using MMPA (n=62) and a modified minimally invasive epivastus approach (n=65) within the period from January to December, 2022. The study groups were comparable by gender, age, BMI, gonarthrosis stage, and knee joint functioning parameters.
UNASSIGNED: The surgery duration in the epivastus group was significantly lower compared to MMPA group (p<0.001). However, the interpretation of tissue trauma markers assessment appeared rather ambiguous. There were no statistically significant differences in lactate dehydrogenase (p=0.253). C-reactive protein, myoglobin, creatinine showed a significant increase in MMPA group (p<0.001; p=0.002 and p=0.048, respectively), while aspartate aminotransferase, creatine phosphokinase and ESR, in contrast, increased in the epivastus group (p<0.001; p=0.024 and p=0.010, respectively). Pain syndrome determined by VAS 3 days after the surgery was significantly lower in the epivastus group (p=0.006). The extent of blood loss appeared to be much greater in MMPA group (p=0.006). The joint function indicators on day 3 after the surgery were found to be better in the patients after TKA using an epivastus approach (p<0.001). The postoperative assessment of the endoprosthetic spatial orientation showed the indicators characterizing the correct endoprosthetic implantation to be comparable in both groups (p≥0.06).
UNASSIGNED: The present study demonstrated the efficiency of the developed minimally invasive (epivastus) approach in TKA. However, it should be taken into consideration that surgeons should take a training course to be able to accomplish a high-quality approach.An ambiguous interpretation of tissue trauma markers assessment of performing minimally traumatic approaches requires terminology correction. It is probably necessary to change the approach to the approach marking and use the terms specifying minimal invasiveness and the reduction of muscle injury rather than soft tissues in general.
UNASSIGNED: A single-center, comparative randomized prospective study involved 127 patients, who underwent TKA using MMPA (n=62) and a modified minimally invasive epivastus approach (n=65) within the period from January to December, 2022. The study groups were comparable by gender, age, BMI, gonarthrosis stage, and knee joint functioning parameters.
UNASSIGNED: The surgery duration in the epivastus group was significantly lower compared to MMPA group (p<0.001). However, the interpretation of tissue trauma markers assessment appeared rather ambiguous. There were no statistically significant differences in lactate dehydrogenase (p=0.253). C-reactive protein, myoglobin, creatinine showed a significant increase in MMPA group (p<0.001; p=0.002 and p=0.048, respectively), while aspartate aminotransferase, creatine phosphokinase and ESR, in contrast, increased in the epivastus group (p<0.001; p=0.024 and p=0.010, respectively). Pain syndrome determined by VAS 3 days after the surgery was significantly lower in the epivastus group (p=0.006). The extent of blood loss appeared to be much greater in MMPA group (p=0.006). The joint function indicators on day 3 after the surgery were found to be better in the patients after TKA using an epivastus approach (p<0.001). The postoperative assessment of the endoprosthetic spatial orientation showed the indicators characterizing the correct endoprosthetic implantation to be comparable in both groups (p≥0.06).
UNASSIGNED: The present study demonstrated the efficiency of the developed minimally invasive (epivastus) approach in TKA. However, it should be taken into consideration that surgeons should take a training course to be able to accomplish a high-quality approach.An ambiguous interpretation of tissue trauma markers assessment of performing minimally traumatic approaches requires terminology correction. It is probably necessary to change the approach to the approach marking and use the terms specifying minimal invasiveness and the reduction of muscle injury rather than soft tissues in general.
摘要：
该研究的目的是通过将其早期结果与标准内侧髌骨入路（MMPA）的结果进行比较，来评估全膝关节置换术（TKA）中先进的微创（表皮）入路的效率。
■单中心，比较随机前瞻性研究涉及127例患者，在1月至12月期间，使用MMPA（n=62）和改良的微创上腹入路（n=65）进行了TKA，2022年。研究组在性别上具有可比性，年龄,BMI,关节炎阶段，和膝关节功能参数。
■与MMPA组相比，表皮组的手术时间显着降低（p<0.001）。然而,组织创伤标志物评估的解释似乎相当模糊.乳酸脱氢酶差异无统计学意义(p=0.253)。C反应蛋白,肌红蛋白,MMPA组肌酐显著升高(p<0.001;p=0.002和p=0.048),而天冬氨酸转氨酶,肌酸磷酸激酶和ESR，相比之下,在表皮组增加（p<0.001;p=0.024和p=0.010，分别）。手术后3天通过VAS确定的疼痛综合征在表皮组明显较低（p=0.006）。MMPA组的失血程度似乎更大（p=0.006）。术后第3天的关节功能指标在TKA术后使用表皮浮游入路的患者中被发现更好(p<0.001)。术后对假体空间方向的评估显示，两组中表征正确假体植入的指标具有可比性（p≥0.06）。
■本研究证明了开发的微创（表皮）方法在TKA中的有效性。然而,应该考虑到外科医生应该参加培训课程，以便能够完成高质量的方法。对组织创伤标志物评估执行最小创伤方法的模棱两可的解释需要术语校正。可能有必要改变入路标记的方法，并使用指定最小侵入性和减少肌肉损伤的术语，而不是一般的软组织。
■单中心，比较随机前瞻性研究涉及127例患者，在1月至12月期间，使用MMPA（n=62）和改良的微创上腹入路（n=65）进行了TKA，2022年。研究组在性别上具有可比性，年龄,BMI,关节炎阶段，和膝关节功能参数。
■与MMPA组相比，表皮组的手术时间显着降低（p<0.001）。然而,组织创伤标志物评估的解释似乎相当模糊.乳酸脱氢酶差异无统计学意义(p=0.253)。C反应蛋白,肌红蛋白,MMPA组肌酐显著升高(p<0.001;p=0.002和p=0.048),而天冬氨酸转氨酶,肌酸磷酸激酶和ESR，相比之下,在表皮组增加（p<0.001;p=0.024和p=0.010，分别）。手术后3天通过VAS确定的疼痛综合征在表皮组明显较低（p=0.006）。MMPA组的失血程度似乎更大（p=0.006）。术后第3天的关节功能指标在TKA术后使用表皮浮游入路的患者中被发现更好(p<0.001)。术后对假体空间方向的评估显示，两组中表征正确假体植入的指标具有可比性（p≥0.06）。
■本研究证明了开发的微创（表皮）方法在TKA中的有效性。然而,应该考虑到外科医生应该参加培训课程，以便能够完成高质量的方法。对组织创伤标志物评估执行最小创伤方法的模棱两可的解释需要术语校正。可能有必要改变入路标记的方法，并使用指定最小侵入性和减少肌肉损伤的术语，而不是一般的软组织。
