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-  2016 

人工全膝关节置换术中滑移截骨矫正重度外翻畸形的疗效观察

DOI: doi:10.7507/1002-1892.20160029

Keywords: 人工全膝关节置换术, 膝外翻畸形, 滑移截骨, 软组织松解平衡

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Abstract:

目的探讨人工全膝关节置换术(total knee arthroplasty,TKA)中采用内侧副韧带起点向上滑移截骨矫正重度膝外翻畸形的手术技巧及疗效。 方法2008年6月-2014年2月,收治18例(19膝)伴重度膝关节外翻畸形拟行TKA患者。男6例,女12例;年龄29~72岁,平均52.3岁。关节置换原因:骨关节炎3例(3膝),类风湿性关节炎11例(12膝),创伤性关节炎3例(3膝),先天性发育畸形伴髌骨外脱位1例(1膝)。膝关节学会评分系统(KSS)侧方稳定性评分为(6.0±5.4)分,美国特种外科医院(HSS)评分为(41.6±7.7)分。X线片测量示胫股角为(33.0±2.9)°。根据Krackow膝外翻分型标准均为Ⅱ型。置换术中采用内侧副韧带起点向上滑移截骨恢复软组织平衡,矫正外翻畸形。 结果术后切口均Ⅰ期愈合。1例术后发生腓总神经麻痹,予以对症支持治疗,6个月后完全恢复。18例(19膝)均获随访,随访时间19个月~7年,平均5.7年。X线片复查示,术后6个月截骨片均骨性愈合;随访期间假体位置良好,未发现松动、下沉;末次随访时胫股角为(4.8±1.8)°,与术前比较差异有统计学意义(t=62.61,P=0.00)。末次随访时, HSS评分为(87.2±10.5)分,KSS侧方稳定性评分为(12.4±3.1)分,均较术前显著提高,比较差异有统计学意义(t=—33.35,P=0.00;t=—6.83,P=0.00)。 结论对于伴重度膝关节外翻畸形者,TKA术中通过内侧副韧带起点向上滑移截骨可恢复软组织平衡,矫正外翻畸形,获得满意的膝关节稳定性和关节功能

References

[1]  3. Rossi R, Rosso F, Cottino U, et al. Total knee arthroplasty in the valgus knee. Int Orthop, 2014, 38(2):273-283.
[2]  4. Favorito PJ, Mihalko WM, Krackow KA. Total knee arthroplasty in the valgus knee. J Am Acad Orthop Surg, 2002, 10(1):16-24.
[3]  9. Whiteside LA. Selective ligament release in total knee arthroplasty of the knee in valgus. Clin Orthop Relat Res, 1999, (367):130-140.
[4]  10. Engh GA, Ammeen D. Results of total knee arthroplasty with medial epicondylar osteotomy to correct varus deformity. Clin Orthop Relat Res, 1999, (367):141-148.
[5]  11. Healy WL, Iorio R, Lemos DW. Medial reconstruction during total knee arthroplasty for severe valgus deformity. Clin Orthop Relat Res, 1998, (356):161-169.
[6]  12. Ranawat AS, Ranawat CS, Elkus M, et al. Total knee arthroplasty for severe valgus deformity. J Bone Joint Surg (Am), 2005, 87 Suppl 1 (Pt 2):271-284.
[7]  13. Hirschmann MT, Hoffmann M, Krause R, et al. Anterolateral approach with tibial tubercle osteotomy versus standard medial approach for primary total knee arthroplasty:does it matter? BMC Musculoskelet Disord, 2010, 11:167.
[8]  14. Rawal J, Devany AJ, Jeffery JA. Arthroplasty in the valgus knee:Comparison and discussion of lateral vs medial parapatellar approaches and implant selection. Open Orthop J, 2015, 9:94-97.
[9]  15. Sekiya H, Takatoku K, Takada H, et al. Lateral approach is advantageous in total knee arthroplasty for valgus deformed knee. Eur J Orthop Surg Traumatol, 2014, 24(1):111-115.
[10]  16. Miyasaka KC, Ranawat CS, Mullaji A. 10-to 20-year followup of total knee arthroplasty for valgus deformities. Clin Orthop Relat Res, 1997, (345):29-37.
[11]  17. Keblish PA. The lateral approach to the valgus knee. Surgical technique and analysis of 53 cases with over two-year follow-up evaluation. Clin Orthop Relat Res, 1991, (271):52-62.
[12]  18. Boyer P, Boublil D, Magrino B, et al. Total knee replacement in the fixed valgus deformity using a lateral approach:role of the automatic iliotibial band release for a successful balancing. Int Orthop, 2009, 33(6):1577-1583.
[13]  20. Mihalko WM, Whiteside LA. Bone resection and ligament treatment for flexion contracture in knee arthroplasty. Clin Orthop Relat Res, 2003, (406):141-147.
[14]  21. Mullaji AB, Shetty GM. Lateral epicondylar osteotomy using computer navigation in total knee arthroplasty for rigid valgus deformities. J Arthroplasty, 2010, 25(1):166-169.
[15]  1. ?Falez F. Knee arthroplasty today. Int Orthop, 2014, 38(2):221-225.
[16]  2. Nikolopoulos D, Michos I, Safos G, et al. Current surgical strategies for total arthroplasty in valgus knee. World J Orthop, 2015, 6(6):469-482.
[17]  5. Krackow KA, Jones MM, Teeny SM, et al. Primary total knee arthroplasty in patients with fixed valgus deformity. Clin Orthop Relat Res, 1991, (273):9-18.
[18]  6. Engh GA. The difficult knee:severe varus and valgus. Clin Orthop Relat Res, 2003, (416):58-63.
[19]  7. Brilhault J, Lautman S, Favard L, et al. Lateral femoral sliding osteotomy lateral release in total knee arthroplasty for a fixed valgus deformity. J Bone Joint Surg (Br), 2002, 84(8):1131-1137.
[20]  8. Mullaji AB, Shetty GM. Surgical technique:Computer-assisted sliding medial condylar osteotomy to achieve gap balance in varus knees during TKA. Clin Orthop Relat Res, 2013, 471(5):1484-1491.
[21]  19. Ritter MA, Lutgring JD, Davis KE, et al. The role of flexion contracture on outcomes in primary total knee arthroplasty. J Arthroplasty, 2007, 22(8):1092-1096.

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