膝退化性關節炎全人工膝關節置換術–微創手術方式與傳統手術方式之比較

Minimally Invasive Total Knee Arthroplasty Compared with Traditional Total Knee Arthroplasty

江福財(Fu-Tsai Chiang)

指導教授 ： 藍守仁

亞洲大學/健康學院/健康管理研究所/碩士(2008年)

摘要

全人工膝關節置換術已被證實為有效之治療方式且普遍為骨科醫師所接受，此項手術方式開發至今已逾30多年且其追踪20多年之臨床結果深獲信賴。然而嚴重的術後疼痛及漫長的恢復時間及復健工作仍然是傳統全人工膝關節置換術無法克服之最主要課題。近年來微創全人工膝關節置換術廣泛受到注意及重視。國外之研究主要針對膝內翻小於10度或膝外翻小於15度合併膝彎曲攣縮小於10之病人。然而國人懼怕手術治療，導致臨床常見膝彎曲攣縮大於10度以上之病患，徒增手術困難度。我們不清楚是否能複製此項技術到膝內翻小於10度或膝外翻小於15度且膝彎曲攣縮10至15度之膝退化性關節炎患者身上。
此為一回溯性研究用以評估特定條件限制下微創手術相較於傳統手術之安全性、效益性及病人滿意度及殘留膝彎曲攣縮角度。此研究包含48位膝退化性關節炎病人25位接受傳統手術方式，23位接受微創手術方式。結果發現接受微創手術方式之病人平均傷口長度、平均總失血量、平均住院天數均較傳統手術方式為少，具統計上顯著意義。但平均手術時間微創手術方式較長(P<0.05)。微創手術組有一例出現膕肌韌帶損傷，2人出現脛骨處人工關節位置不良(輕度內轉)及1例表淺傷口感染，但上述之併發症不影響最終之手術結果。
早期平均knee society scores包括objective scores及functional scores微創手術組均較傳統手術組為佳，但術後12週時兩者之差異逐漸縮小，術後追踪至6個月及1年兩者結果相近(P>0.05)不具統計上顯著差異。術後追踪一年兩組病人之術後滿意度相似。微創組之殘存膝彎曲攣縮雖較傳統手術方式為高，但P值>0.05不具統計意義，而且主要出現在矮胖型病患(體重>80kg)。就我們完成的23例微創全人工膝關節置換術相較於傳統手術方式早期結果顯示有較少的總失血量，較短的住院天數較快恢復早期活動，術後也沒有較高之併發症，從我們追踪的臨床結果發現微創手術方式，可被安全地複製到我們設定的治療條件下。而且能創造病人功能性之滿意度，然而此項技術仍須要較長的追踪時間來追踪其後續臨床之結果。

關鍵字

微創全人工膝關節置換術 ； 傳統全人工膝關節置換術 ； 膝內翻 ； 膝外翻 ； 膝彎曲攣縮

並列摘要

Total knee arthroplasty was an effectiveness method for treatment the severe osteoarthritis of knee which has been approved and accepted by the orthopedic community. This technique has been developed more than thirty years and the clinical results have been followed up over twenty years and reliable by the orthopedic doctors. But postoperative pain and long period of recovery times and rehabilitation program were the major problems of the traditional total knee arthroplasty. There has been recent attention concerning minimally invasive technique for knee arthroplasty. Reviewing the relative articles, the surgical criterias were limited to knee varus < 10 degree or valgus < 15 degree and flexion contracture < 10 degree. It is not clear whether these complicated technique can be reproduced to knee varus <10 degree, or valgus < 15 degree and flexion contracture 10 to 15 degree.
This prospective study was carried out under the particular criteria to assess safety, satisfaction and efficacy of a minimally invasive total knee arthroplasty comparison to traditional total knee arthroplasty. The study consisted of 48 knees, including 25 knees receiving traditional procedure and 23 knees receiving minimally invasive procedure.
The results revealed that the mean skin length, mean total blood loss, mean hospital staying in the minimally invasive group were shorter than the traditional group and statistic significantly. But the mean operation time was longer (P<0.05) in the minimally invasive group. There were one partial popliteal tendon injury and two tibial component mildly internal rotation in the minimally invasive group. The above complications did not affect the finally clinical results. The early mean knee society scores, including objective and functional scores, minimally invasive group was better than traditional group but the difference got closely after 12 weeks postoperation and similar results were found at 6 months and 12 months following up postoperation. The satisfaction of both groups were similar after one year postoperation. The residual flexion contracture of knee was higher in minimally invasive group, but the p value > 0.05 and no statistic significantly. Most of the cases were shorter and obesity patient (body weight > 80kg). In this study, minimally invasive total knee arthroplasty showed less total blood loss, shorter hospital staying, quickly early range of motion and similar complication rate to traditional total knee arthroplasty. In summary, under the limited criterias, minimally invasive technique could be safety reproducible and created functional satisfaction.
But this technique should need longer period to follow its clinical results.

並列關鍵字

minimally invasive total knee arthroplasty ； traditional total knee arthroplasty ； knee society scores ； knee varus ； valgus ； flexion contracture

參考文獻

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