膝关节骨性关节炎全膝关节置换术后下肢力线与早期临床效果关系的研究  

Relationship between lower limb alignment and early clinical results after TKA for osteoarthritis

作　　者：王波[1] 胡海涛[1] 潘健[1] 简伟明[2] 牛舜[1] 龙华[1] 马保安[1] 

机构地区：[1]第四军医大学唐都医院骨科,陕西西安710038 [2]解放军第175医院医务处

出　　处：《中国骨与关节损伤杂志》2015年第10期1044-1048,共5页Chinese Journal of Bone and Joint Injury

基　　金：全军医学科技"十二五"科研面上项目(CWS11J152)

摘　　要：目的 分析膝关节骨性关节炎全膝关节置换（TKA）术后下肢力线与早期临床效果之间的关系。方法 回顾性分析自2014-01—2014-12行初次TKA的138例（203膝）膝关节骨性关节炎,摄下肢全长X线片（LLR）、测量手术前后胫骨股骨机械轴夹角（MFTA）、股骨远端外侧角（LDFA）、胫骨近端内侧角（MPTA）。采用术后膝关节活动度（ROM）、AKS评分、HSS评分评价TKA效果。将MFTA分为控制在2°以内组和3°以内组讨论下肢力线允许偏离中立位的范围,利用LDFA、MPTA与术后临床效果的关系分析术后下肢力线偏差的主要原因。结果 采用3°作为衡量下肢力线的标准：-3°≤MFTA≤3°组术后AKS关节与功能评分、HSS评分高于MFTA〉3°或MFTA〈-3°组,差异有统计学意义（P〈0.05）;2组术后ROM差异无统计学意义（P〉0.05）。采用2°作为衡量下肢力线的标准：-2°≤MFTA≤2°组与MFTA〉2°或0.05）。分别以3°为标准对LDFA、MPTA进行分组,除术后ROM外,-3°≤LDFA≤3°组AKS关节和功能评分、HSS评分高于LDFA〉3°或〈-3°LDFA组,差异有统计学意义（P〈0.05）;-3°≤MPTA≤3°组与MPTA〉3°或MPTA〈-3°组术后ROM、AKS关节和功能评分、HSS评分差异无统计学意义（P〉0.05）。结论 传统TKA临床效果确切,下肢力线允许偏离中立位的范围为3°,即外翻3°-内翻3°,且引起术后下肢力线偏差的主要原因为股骨远端截骨不够精确。Objective To analyze the relationship between the lower limb alignment and the early clinical results after TKA for osteoarthritis.Methods One hundred and thirty eight osteoarthritis cases（203 knees） in our hospital from January to December of 2014 who accepted primary traditional TKA were retrospectively reviewed.Long leg radiographs（LLR） were acquired before and after TKA,and the mechanical femorotibial angle（MFTA）,the lateral distal femoral angle（LDFA） and the medial proximal tibia angle（MPTA） were measured on them.The range of motion（ROM）,AKS score and HSS score were used to assess the clinical results.In order to discuss the maximum of the lower limb alignment deviated from the neutral mechanical alignment,we divided MFTA into two groups by 2° or 3°.The relationship between LDFA,MPTA and clinical results was used to analyze the main reason of the lower limb malalignment after TKA.Results When MFTA was divided by3°,the AKS score and HSS score of the group of-3° ≤MFTA ≤3° were higher than that of the group of MFTA 3° and MFTA-3°,and the difference was statistically significant（P〈0.05）,while the difference of the ROM between the two groups was not statistically significant（P〉0.05）; and when MFTA was divided by 2°,except for the AKS knee score,the AKS functional score,HSS score and the ROM between the group of-2°≤MFTA≤2°and the group of MFTA2° and MFTA-2°were not statistically significant（P〉0.05）.When LDFA and MPTA were divided by 3°,the AKS score and HSS score except for ROM were higher in the group of-3° ≤LDFA ≤3° than the group of LDFA 3° and LDFA -3°,and the difference was statistically significant（P〈0.05）,while the AKS score,HSS score and the ROM between the group of-3°≤MPTA≤3°and the group of MPTA3° and MPTA-3° was not statistically significant（P〉0.05）.Conclusion The traditional TKA is an effective and reliable therapy for osteoarthritis.The maximum of the lower limb alignment deviated from the neutral mechanical ali

关 键 词：膝关节 骨性关节炎 全膝关节置换术 下肢力线 膝关节活动度 AKS评分 HSS评分 

分 类 号：R687.42[医药卫生—骨科学]