臨床整形外科49巻6号

2014年06月発行

誌上シンポジウム MIS人工膝関節置換術の現状と展望

MIS人工膝関節置換術後の筋力の推移

著者： 眞島任史¹ 西池修² 笠原靖彦³ 須々田幸一⁴

所属機関： ¹国際医療福祉大学病院整形外科 ²釧路三慈会病院整形外科 ³北海道大学病院整形外科 ⁴新札幌整形外科病院

ページ範囲：P.507 - P.510

文献概要

　最小侵襲人工膝関節置換術(MIS-TKA)の筋力と可動域の推移を調べた結果，MIS-TKA群の術後筋力は従来法に比べ速やかに回復し，術後4週まで有意に高かった．一方，筋力の差は術後3カ月で消失し，術後5年の最終観察時も差を認めなかった．膝可動域も筋力と同様の推移を示した．MIS-TKAは皮切の長さや美容的な外観のためだけにあるのではなく，たとえ短期であっても筋力回復が早いことは在院日数の短縮につながる．このことは医療費という観点からMIS-TKAが有効であることを示していると考える．

参考文献

1) Boerger TO, Aglietti P, Mondanelli N:Minisubvastus versus medial parapatellar approach in total knee arthroplasty. Clin Orthop Relat Res 440:82-87, 2005

2) Bonutti PM, Neal DJ, Kester MA:Minimal incision total knee arthroplasty using the suspended leg technique. Orthopedics 26:899-903, 2003

3) Bonutti PM, Mont MA, Kester MA:Minimally invasive total knee arthroplasty:a 10-feature evolutionary approach. Orthop Clin North Am 35:217-226, 2004

4) Dalury DF, Dennis DA:Mini-incision total knee arthroplasty can increase risk of component malalignment. Clin Orthop Relat Res 440:77-81, 2005

5) Haas SB, Cook S, Beksac B:Minimally invasive total knee replacement through a mini midvastus approach:a comparative study. Clin Orthop Relat Res 428:68-73, 2004

6) Kelly MA, Clarke HD:Long-term results of posterior cruciate-substituting total knee arthroplasty. Clin Orthop Relat Res 404:51-57, 2002

7) Laskin RS, Beksac B, Phongjunakorn A, et al:Minimally invasive total knee replacement through a mini-midvastus incision:an outcome study. Clin Orthop Relat Res 428:74-81, 2004

8) Laskin RS:Minimally invasive total knee replacement using a mini-mid vastus incision technique and results. Surg Technol Int 13:231-238, 2004

9) Mizner RL, Petterson SC, Stevens JE, et al:Early quadriceps strength loss after total knee arthroplasty:the contributions of muscle atrophy and failure of voluntary muscle activation. J Bone Joint Surg Am 87:1047-1053, 2005

10) 西池　修，眞島任史，山崎修司・他：大腿四頭筋温存最小侵襲人工膝関節全置換術の短期成績．臨整外：1101-1109，2006

11) Pagnano MW, Meneghini RM:Minimally invasive total knee arthroplasty with an optimized subvastus approach. J Arthroplasty 21 (4 supple 1):22-26, 2006

12) Ranawat CS, Flynn WF, Saddler S, et al:Long-term results of the total condylar knee arthroplasty:a 15-year survivorship study. Clin Orthop Relat Res 286:94-102, 1993

13) Repicci JA, Eberle RW:Minimally invasive surgical technique for unicondylar knee arthroplasty. J South Orthop Assoc 8:20-27, 1999

14) Roysam GS, Oakley MJ:Subvastus approach for total knee arthroplasty:a prospective, randomized, and observer-blinded trial. J Arthroplasty 16:454-457, 2001

15) Tria Jr AJ, Coon TM:Minimal incision total knee arthroplasty early experience. Clin Orthop Relat Res 416:185-190, 2003

16) Tria Jr AJ:Minimally invasive total knee arthroplasty:the importance of instrumentation. Orthop Clin North Am 35:227-234, 2004

17) YANO Research:Orthopedic Medical Device Market in Japan 2009．Tokyo, Japan:Yano Research Institute Ltd;77,2009