评价自制组配式截骨工具行微创全膝关节置换术的临床及早期随访效果。

对95例中山大学附属第一医院关节外科行全膝关节置换的重度膝关节骨关节炎的患者随机分组，分别使用自制组配式截骨工具行微创全膝关节置换术或常规全膝关节置换术。对患者术前、术后的膝关节评分法(KSS)、视觉模拟评分法(VAS)、X线影像学(下肢力线、股骨角、胫骨角和胫骨平台后倾角)进行随访对比研究，微创组和传统组之间的差异采用独立样本t检验进行比较。

成功随访2年以上的手术患者87例，其中微创组42例，传统组45例。微创组手术时间比传统组长(t＝9.275，P<0.05)，但两组在术中出血量、输血量、引流量的比较无统计学差异(P>0.05)。两组患者均未出现皮肤坏死，深部感染和神经血管损伤的并发症。下肢力线、股骨角、胫骨角和胫骨平台后倾角比较无统计学差异(P>0.05)。术后2周内，KSS评分、VAS评分微创组要优于传统组(t＝1.518，P<0.05)(除外术后第2周KSS临床评分)，但术后3月后两组比较无统计学差异(P>0.05)。

自制组配式截骨工具行微创全膝关节置换手术早期的临床效果要优于常规人工全膝关节置换术，两组的影像学结果相当，但尚需更长时间的随访以全面评价其临床疗效。

To evaluate the clinical efficacy of applying self-designed modular osteotomy instrumentation in minimally invasive total knee arthroplasty and the outcomes of the early follow-up.

A total of 95 patients with severe osteoarthritis of the knee underwent total knee arthroplasty in the First Affiliated Hospital of Sun Yat-sen University were randomly divided into the minimally invasive and conventional groups. The minimally invasive group were treated with minimally invasive total knee arthroplasty applying self-designed modular osteotomy instrumentation. Preoperative and postoperative Knee Society score (KSS), visual analogue scale (VAS) and Ⅹ-ray image data (axial alignment of lower extremity, femural angle, tibial angle and posterior tibial slope, ) were statistically compared between two groups by subsequent follow-up by student t test.

In total, 87 patients were followed up for over two years, 42 in the minimally invasive group and 45 in the conventional group. In the minimally invasive group, the operation time was considerably longer than that in the conventional group (t=9.275, P<0.05). Intraoperative hemorrhage, transfusion and drainage volumes did not significantly differ between two groups (all P>0.05). No skin necrosis, deep infection or nerve blood vessel injury was observed in two groups. X-ray imaging data, such as axial alignment of lower extremity, femoral angle, tibial angle and posterior tibial slope did not significantly differ between two groups (all P>0.05). During two-week follow-up, parameters including KSS, VAS in the minimally invasive group were significanly higher than those in the conventional group (t=1.518 P<0.05), except KSS clinical score at postoperative two weeks which was not significant different (P>0.05). However, the scores of each parameter did not significantly differ between two groups after three-month follow-up(P>0.05).

Minimally invasive total knee arthroplasty using the self-designed modular osteotomy instrumentation yields higher short-term clinical efficacy and a similar radiological results compared with conventional artificial TKA; the whole clinical efficacy remains to be further investigated by a longer follow-up.