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-  2015 

个体化股骨远端外翻角度截骨技术在初次人工全膝关节置换术中的应用

DOI: doi:10.7507/1002-1892.20150007

Keywords: 人工全膝关节置换术, 截骨术, 股骨解剖轴夹角, 机械胫股角

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Abstract:

目的探讨初次人工全膝关节置换术(total knee arthroplasty,TKA)中,应用个体化股骨远端外翻角度截骨技术对改善术后下肢冠状面力线的可行性以及疗效。 方法回顾分析2013年1月-2月接受单膝TKA并符合选择标准的50例退行性骨关节炎患者临床资料。其中25例TKA中采用个体化股骨远端外翻角度截骨技术(试验组),25例采用传统股骨远端外翻5°截骨技术(对照组)。两组患者性别构成、年龄、身体质量指数、病程、患膝侧别、骨关节炎分级以及术前股骨解剖轴夹角(femoral mechanical anatomical angle,FMA)、机械胫股角(mechanical femorotibial angle,MFT)、膝关节学会评分系统(KSS)比较,差异均无统计学意义(P>0.05)。术后3d摄下肢全长X线片,测量并比较两组MFT;术后6、15个月采用KSS评分评价膝关节功能。 结果术后3 d X线片示试验组MFT为(—0.20±1.87)°,对照组为(1.71±3.67)°,比较差异有统计学意义(t=2.32,P=0.02);其中试验组22例(88%)MFT达理想角度(0±3)°,显著高于对照组的16例(64%)(χ2=2.32,P=0.02)。两组切口均Ⅰ期愈合,无下肢深静脉血栓形成等并发症发生。两组患者术后均获随访15个月,试验组术后6、15个月膝关节KSS评分分别为(88.23±2.57)、(90.76±2.77)分,显著高于对照组的(82.92±2.59)、(88.65±1.77)分,比较差异均有统计学意义(t=7.26,P=0.00;t=3.20,P=0.02)。末次随访X线片示假体均无松动征象。 结论与传统股骨远端外翻5°截骨技术相比,初次TKA中采用个体化股骨远端外翻角度截骨技术可更好改善MFT角,有利于膝关节功能的早期恢复

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