Total diz artroplastisinde minimal invazif midvastus ve standart medial parapatellar yaklaşımların karşılaştırması

Abstract

Amaç: Çalışmada minimal invazif midvastus insizyon (MMV) tekniği ve standart medial parapatellar teknikle (ST) yapılan total diz protezlerinin (TDP) kısa dönem sonuçlarının karşılaştırılması amaçlandı. Çalışma planı: Çalışmada TDP ameliyatı ST ile yapılan 20 hasta (18 erkek, 2 kadın; ort. yaş 67.25± 6.7) ile MMV yöntemle yapılan 19 hasta (4 erkek, 15 kadın; ort. yaş 64.53±7.53) geriye dönük olarak değerlendirildi. İki grup ameliyat süresi, kan kaybı, ameliyat sonrası düz bacak kaldırmaya başlama zamanı (DBK), eklem hareket açıklığı ve Knee Society (KSS) ve Hospital for Special Surgery (HSS) skorları yönünden karşılaştırıldı. Radyolojik olarak ise ameliyat öncesi ve sonrası ayakta çekilen boy filmleriyle değerlendirme yapıldı. Ortalama takip süresi ST grupta 29.4±8.2 ay, MMV grupta ise 17.7±11.1 aydı. Bulgular: Ameliyat sonrası erken dönemde (10. gün), eklem hareket açıklığı (EHA) yönünden MMV grubunun ST grubundan anlamlı derecede üstün olduğu gözlendi. DBK zamanı ve kan kaybı yönünden de MMV grubu anlamlı olarak üstündü. Bununla birlikte 6. aydan sonra EHA, KSS ve HSS değerleri açısından iki grup arasında anlamlı fark olmadığı saptandı (p>0.05). Ameliyat süresi MMV grubunda anlamlı olarak, ortalama 22 dakika daha uzundu. Radyolojik olarak ise her iki grupta da ideal dizilimin sağlandığı görüldü. Derin veya yüzeyel enfeksiyon saptanmazken, MMV gruptaki iki hastada klinik takiplerle düzelen cilt problemi gözlendi. Çıkarımlar: Standart teknikle kıyaslandığında MMV yaklaşımı ile yapılan TDP ameliyatı erken dönemde fonksiyonel olarak daha iyi sonuçlar vermekte, ancak 6. ay sonrasında her iki tekniğin sonuçları da benzer olmaktadır.

Keywords

• Total diz artroplastisi; minimal invazif; midvastus yaklaşımı; medial parapatellar yaklaşım

Minimal invasive midvastus versus standard parapatellar approach in total knee arthroplasty

Abstract

Objective: The aim of this study was to compare the short-term results of total knee arthroplasty (TKA) surgeries performed with minimally invasive mini-midvastus (MMV) incision and the standard medial parapatellar technique (ST).
Methods: Twenty patients (18 males, 2 females; mean age: 67.25±6.70) operated with the ST and 19 patients (4 males, 15 females; mean age: 64.53±7.53) operated with the MMV approach were retrospectively evaluated. The surgery time, blood loss, time to straight leg raise (SLR) postoperatively, range of motion (ROM) and Knee Society (KSS) score and Hospital for Special Surgery (HSS) score were compared between the groups. Radiological evaluation was made with standing orthoroentgenographs both pre- and postoperatively. Mean follow-up time was 29.4±8.2 months in the ST and 17.7±11.1 months in the MMV group.
Results: In the early postoperative period (10th day), the MMV group was significantly better than the ST group in terms of ROM. Time to SLR and blood loss values were also significantly better in the MMV group. However, there was no significant difference between the groups after the sixth month, for ROM, KSS and HSS values (p>0.05). Surgery time was significantly longer (with a mean difference of 22 minutes) in the MMV group. Radiological examination revealed ideal alignment in both groups. No deep or superficial infection was detected. Two patients in the MMV group had skin problems which healed after clinical follow-up.
Conclusion: Our results suggested that functional results of TKAs performed via the MMV approach are better in the first six months when compared to those of the ST.

Keywords

• Total knee arthroplasty
• minimal invasive
• midvastus approach
• medial parapatellar approach

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