髂胫束松解在外翻膝全膝关节置换术中的作用  

Role of iliotibial band release for fixed valgus deformity in total knee arthroplasty

作　　者：王宏伟[1] 周殿阁[2] 

机构地区：[1]北京市大兴区红星医院骨科,北京100076 [2]北京大学人民医院骨关节病诊疗研究中心

出　　处：《中国骨与关节损伤杂志》2015年第8期812-814,共3页Chinese Journal of Bone and Joint Injury

摘　　要：目的 探讨固定性膝外翻全膝关节置换（TKA）术中髂胫束松解的作用。方法 自2009-05—2012-11对22例（24膝）膝关节骨性关节炎并膝外翻畸形行TKA,采用外侧入路,髂胫束多点切开延长松解,Z形切开关节囊,松解髂胫束止点后记录伸直位外翻角度。以股骨及胫骨侧外侧副韧带及腘肌腱为主进一步进行软组织平衡。股骨远端5°-7°外翻截骨,均采用后稳定骨水泥型假体,行髌骨置换。结果 本组术中测量髂胫束松解后外翻角平均11.6°（5°-15°）,松解前平均27.6°（20°-35°）,松解后平均矫正角度为16°。术后恢复良好,未出现腓总神经麻痹。术后外翻角平均6.9°（5°-9°）。22例均获得平均18.9（5-30）个月随访,期间所有患者胫股角稳定,膝关节活动度平均119.2°（100°-125°）。末次随访时,KSS评分平均87.3分,较术前提高62.2分;功能评分平均89.7分,较术前提高65.2分。结论 在固定性膝外翻TKA术中,松解髂胫束最大可矫正伸直位外翻20°以内的畸形,改善了髌骨轨迹,明显降低了腓总神经受压麻痹的发生率,不同程度改善了屈曲位外侧间隙紧张。Objective To investigate the effect of iliotibial band release for fixed valgus deformity in total knee arthroplasty （TKA）. Methods Twenty two patients（24 knees） with knee osteoarthritis undergoing TKA for fixed valgus deformity from May 2009 to November 2012 were retrospectively reviewed. After incision of the skin through lateral knee,iliotibial band was prolonged and released. The joint capsule was cut through a ＂zigzag＂ plasty. The valgus angle was measured and recorded during operation. Soft tissue balance was performed by releasing popliteal tendon and lateral collateral ligament from the femur and tibial side. Valgus angle of distal femur cutting were 5 to 7 degree. All patellae of the group were resuffaced with cemented prosthesis. Results During the operation, the average femorofibial angle was corrected from the 27.6°（20°-35°） to 11.6°（5°-15°） after iliotibial band was released. The average corrective angle after release was nearly approaching to 16°. The mean mechanical axis was 6.9°（5°-9°） of valgus postoperatively. All patients received good postoperative recovery and no peroneal nerve palsy was reported.The average range of motion was improved to the post-operative 119.2°（100°-125°） after a mean 18.9 months follow-up（range from 5-30 months）. The average Knee Score System（ILSS） score and functional score were improved to a pest-operative 87.3 points by an increase of 62.2 points, and 89.7 points by an increase of 65.2 points respectively. Conclusion For TKA with fixed valgus knee,releasing of iliotibial band can effectively smooth the patellar tracking, reduce the incidence of common peroneal nerve compression palsy, and alleviate the tension of lateral capsule in flexion.

关 键 词：膝关节骨性关节炎 固定性膝外翻畸形 全膝关节置换术 髂胫束松解 

分 类 号：R687.42[医药卫生—骨科学]