屈膝90°外侧胫股关节间隙确定内翻膝人工全膝关节置换术胫骨截骨量的临床研究  

DETERMINATION OF TIBIAL BONE RESECTION THICKNESS BY LATERAL TIBIOFEMORAL JOINT 90° FLEXIONAL GAP IN TOTAL KNEE ARTHROPLASTY FOR VARUS OSTEOARTHRITIC KNEES

作　　者：王磊[1] 孙振辉[2] 孙云波[2] 张东亮[2] 田孟强[2] 冯世庆[1] 

机构地区：[1]天津医科大学总医院骨科,天津300052 [2]天津市人民医院关节外科

出　　处：《中国修复重建外科杂志》2014年第12期1453-1458,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨屈膝90°外侧胫股关节间隙确定内翻膝人工全膝关节置换术（total knee arthroplasty,TKA）中胫骨截骨量的临床效果。方法选取2013年3月-6月收治且符合选择标准的内翻型膝关节骨关节炎患者60例（60膝）,随机分为两组（n=30）。对照组TKA术中采用传统确定胫骨截骨量方法,试验组术中根据屈膝90°外侧胫股关节间隙确定截骨量。两组患者性别构成、年龄、关节侧别、身高体重指数及术前膝关节学会评分系统（KSS）评分、膝关节活动度、胫股解剖角（anatomic tibiofemoral angle,ATFA）、髌骨倾斜角、股骨后髁偏距（posterior condylar offset,PCO）、关节线高度比较,差异均无统计学意义（P〉0.05）,具有可比性。术中测量股骨远端外髁、股骨后外髁、胫骨外侧平台截骨厚度,随访摄X线片测量ATFA、髌骨倾斜角、PCO、关节线高度,采用膝关节学会评分系统（KSS）评分以及关节活动度评价关节功能恢复情况。结果术中试验组胫骨外侧平台及股骨远端外髁截骨量显著低于对照组,股骨后外髁截骨量高于对照组（P〈0.05）。试验组选择10 mm垫片者（19例）显著多于对照组（8例）（Z=—4.040,P=0.003）。患者均获随访,随访时间13-16个月,平均14.5个月。术后6周两组ATFA、髌骨倾斜角及关节线高度比较,差异均无统计学意义（P〉0.05）;试验组PCO明显小于对照组（P〈0.05）。两组术后12个月KSS评分及膝关节活动度均明显优于术前（P〈0.05）,且试验组以上两指标明显优于对照组（P〈0.05）。结论内翻型膝关节骨关节炎TKA术中,采用屈膝90°外侧胫股关节间隙确定胫骨截骨量方法能减少胫骨平台和股骨远端截骨,有效恢复关节线和PCO,术后早期膝关节功能恢复良好。Objective To investigate the efficiency of total knee arthroplasty（TKA） for varus osteoarthritic knees with tibial bone resection determined by lateral tibiofemoral joint 90° flexional gap measurement.Methods Between March and June 2013,60 patients（60 knees） with varus osteoarthritic knees underwent TKA.All patients were randomly divided into traditional osteotomy group（control group,30 cases） and lateral tibiofemoral joint 90° flexional gap measurement resection group（trial group,30 cases）.There was no significant difference in gender,age,affected side,body mass index and preoperative knee society score（KSS）,range of motion（ROM） of the knee,anatomic tibiofemoral angle（ATFA）,patellar tilt angle,posterior condylar offset（PCO）,and joint line height between 2 groups（P〈0.05）.The bone resection thickness of the distal femoral lateral condyle,femoral posterior lateral condyle,and lateral tibial plateau were measured;and the X-ray films were taken to measure and compare ATFA,patellar tilt angle,PCO,and joint line height after TKA.The knee function recovery was evaluated with KSS score and ROM of the knee.Results The bone resection thickness of the lateral tibial plateau and distal femoral lateral condyle in trial group was significantly smaller than that in control group（P〈0.05）;while the bone resection thickness of the femoral posterior lateral condyle was significantly bigger than that in control group（P〈0.05）.The 10 mm polyethylene insert was used in 19 cases of the trial group and in 8 cases of the control group,showing significant difference（Z=4.040,P=0.003）.All the patients were followed up 13-16 months（mean,14.5 months）.Radiography at 6 weeks after TKA indicated that the ATFA,patellar tilt angle,and joint line height had no significant difference between 2 groups（P〉0.05）;the PCO of trial group was significantly lower than that of control group（P〈0.05）.The KSS score and ROM of the knee at 12 months after operation were significantly improved w

关 键 词：人工全膝关节置换术 胫股关节 股骨后髁偏距 截骨量 

分 类 号：R687.4[医药卫生—骨科学]