全膝关节置换治疗中重度膝内翻畸形  

Total knee arthroplasty for varus deformity: technique and results in 50 knees varus more than 10 degrees

作　　者：苏伟平[1] 雷鹏飞[1] 谢杰[1] 李明清[1] 曾敏[1] 胡懿郃[1] 

机构地区：[1]中南大学湘雅医院骨科

出　　处：《中国矫形外科杂志》2015年第21期1928-1932,共5页Orthopedic Journal of China

基　　金：国家自然科学基金资助项目(编号:81371934);湖南省自然科学基金重点项目(编号:12JJ2055);湖南省科技计划项目资助项目(编号:2011FJ6085)

摘　　要：[目的]评估应用全膝关节置换术治疗膝关节骨性关节炎伴中重度膝内翻畸形的中期疗效,并探究手术技巧及相关经验。[方法]回顾性分析2008年2月~2013年10月应用全膝关节置换术治疗膝关节骨性关节炎伴中重度膝内翻畸形（内翻〉10°）病例50例（50膝）,其中原发骨性关节炎36例,类风湿性关节炎14例。平均病程12.5年（3~24年）,均采用后稳定型假体,术中应用骨赘清理、缩小胫骨平台截骨、选择性的软组织松解等技术矫正膝内翻畸形,术后采取常规抗凝及对症的康复治疗。术前及术后摄取X线片测量患者股胫角,记录手术时间、术中及术后显性失血量,定期随访行X线复查假体位置,检查膝关节活动度并进行KSS评分。[结果]平均随访时间25个月（15~60个月）。无失访病例。手术时间58~94 min,平均73 min,显性失血量650~1 025 ml,平均770 ml,膝关节平均股胫角由术前的内翻13.1°改善成为术后外翻5.3°,置换后有3例术后出现膝关节僵硬并发症,13例术后出现膝前痛。无血管及神经损伤、髌骨骨折、髌骨低位等并发症发生,下肢力线均恢复正常。随访期间复查X线片,未出现假体松动、下沉等并发症,末次随访膝关节活动度、膝关节KSS评分显著优于术前（P〈0.05）。[结论]膝关节骨性关节炎伴重度内翻畸形行全膝关节置换术治疗,术中应用骨赘清理、缩小胫骨平台截骨及选择性软组织松解等手术技巧,内翻畸形可得到纠正,术后下肢力线恢复,随访膝关节活动度及功能较前明显改善,中期临床效果满意。[Objective] To evaluate the mid- term effectiveness of correcting varus knee by total knee arthroplasty as well as to explore the surgical skills and experience. [Methods] A retrospective analysis was made on the clinical data of 50 patients（ 50 knees） who received total knee arthroplasty for correcting moderate（ 10° - 15°） and severe（ 〉15°） varus knee between February 2008 and October 2013. There were 36 primary knee osteoarthritis and 14 rheumatoid arthritis among them. The duration of disease ranged from 3 to 24 years（ mean,12. 5 years）.A cemented,posterior cruciate- substituting design was used for all cases. After removal of osteophytes and reduction of osteotomy,selected soft tissue release were carried out to correct varus knee. Conventional anticoagulants and rehabilitation were given postoperatively. The tibiofemoral angle,operation time,the overt blood loss volume peri- and post- operation and drainage-tubes removal time were recorded. The range of motion were observed regularly and the results were evaluated according to Knee Society Score（ KSS）. Statistic analysis was made by using SPSS19. 0 software. [Results] All patients were followed up for 15~ 60 months（ mean,25 month）,without withdrawn cases. The operation time ranged from 58 to 94 minutes（ mean,73 minutes）. The overt blood loss volume peri- and post- operaton ranged from 650 to 1 025 ml（ mean,770 ml）. Mean tibiofemoralvarus of 13. 1°preoperatively was corrected to 5. 3 valgus postoperatively,knee stiffness occurred in 3 patients,anterior pain of knee occurred in 13 patients. No neurovascular injury,patellar fracture and patella baja happened. The lower limb alignment resumed normal. The X- ray fims showed no evidence of obvious radiolucent line,osteolysis,prosthesis subsidence and limb alignment change. The results of KSS and ROM of knee at last follow- up were significantly better than preoperative ones,with significant difference（ P 〈0. 05）. [Conclusion] The mid- term effectiveness of total knee art

关 键 词：膝关节置换术 膝内翻畸形 缩小胫骨平台截骨 软组织松解 骨缺损 

分 类 号：R687.4[医药卫生—骨科学]