陈旧性股骨骨折畸形愈合继发膝关节骨关节炎的手术治疗  

Surgical treatment for knee osteoarthritis subsequent to previous femur fractures

作　　者：贺强[1] 孙彩虹 马建兵[1] 肖琳[1] 孙相祥[1] 李辉[1] 张维杰[1] He Qiang, Sun Caihong, Ma Jianbing, Xiao Lin, Sun Xiangxiang, Li hui, Zhang Weijie(Department of Joint Surgery, Honghui Hospital, Xi ＇an Jiaotong University, Xi＇an 710054, China （He Q, Ma JB, Xiao L, Sun XX, Li H, Zhang WJ）; Department of Information, 451st Hospital of PLA, Xi ＇an 710054, China （Sun CH）)

机构地区：[1]西安交通大学附属红会医院关节外科,710054 [2]解放军第四五一医院信息科,西安710054

出　　处：《中华骨科杂志》2018年第7期411-417,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨陈旧性股骨骨折畸形愈合继发膝关节骨关节炎行全膝关节置换或截骨术的适应证及疗效。方法回顾性分析2006年2月至2017年2月收治的6例陈旧性股骨骨折畸形愈合继发膝关节骨关节炎患者，男3例，女3例；年龄51-79岁，平均（58．2±10．3）岁。4例采用全膝关节置换术，2例采用截骨术。关节置换组患者平均年龄为（60．5±12．3）岁，截骨手术组患者年龄分别为51和55岁。在双下肢全长X线片中测量术前股骨侧冠状面畸形角、术前股骨远端机械轴外侧角、术前和术后髋膝踝角。术前关节置换组股骨侧冠状面畸形角平均为17．0°±7．7°，截骨手术组分别为34°和20°；关节置换组股骨远端机械轴外侧角均在87°±7°范围内，截骨手术组在870±70范围外；关节置换组髋膝踝角平均为161．8°±8．0°，截骨手术组分别为155°和160°。以膝关节活动度和美国膝关节协会评分（Knee Society Score，KSS）评估膝关节功能。比较采用两种术式患者术后髋膝踝角、膝关节活动度和KSS评分的差异。结果术后1年，关节置换组平均髋膝踝角增加至176．0°±2．8°，截骨手术组分别增加至177°和175°。术后1年膝关节活动度由术前71°±16°增加至113°±5°，活动度得到明显改善；其中关节置换组膝关节活动度113．0°±6．8°，截骨手术组分别为110°和115°术后1年KSS评分由术前（46±3）分增加至（88±3）分，功能评分得到明显提高；其中关节置换组KSS为（88．8±3．0）分，截骨手术组分别为85分和82分。2例截骨手术患者均未发生骨不连，截骨处愈合良好。结论对股骨陈旧性骨折畸形愈合继发膝关节骨关节炎患者，在严格选择手术适应证的前提下采用全膝关节置换术或截骨手术均可取得良好的早期临床疗效。Objective To investigate the indications and clinical outcomes of total knee arthroplasty or osteotomy for knee osteoarthritis subsequent to previous femur fractures. Methods Six patients （three male and three female） with knee osteo- arthritis subsequent to previous femur fractures were analyzed retrospectively between February 2006 and February 2017. The av- erage age of patients was 58.2± 10.3 years old, ranged from 51 to 79 years. Four patients underwent total joint replacement and two underwent osteotomy. The average age of patients in joint replacement group was 60.5± 12.3 years old. The age of the two patients in the osteotomy group was 51 and 55 years old, respectively. The extra-articular deformity angle of the coronal plane of the femur, lateral distal femur angle of mechanical axis, hip-knee-ankle angle （HKA） of preoperative and postoperative were determined on long-standing radiography. The mean angle of the extra-articular deformity in the joint replacement group was 17.0±7.7 degrees. The angle of the extra-articular deformity in the osteotomy group was 34 and 20 degrees. Lateral distal femur angle of mechanical axis in the joint replacement group was within the range of 87±7 degrees. Lateral distal femur angle of mechanical axis in the oste- otomy group was out of the range of 87±7 degrees. The mean preoperative HKA of the joint replacement group was 161.8±8.0 de- grees. The preoperative HKA of the osteotomy group was 155 and 160 degrees, respectively. Knee function was estimated accord- ing to knee range of motion and Knee Society Score （KSS）. The results of postoperative hip-knee-ankle angle, knee range of motion （ROM） and knee society score were compared between the two groups. Results The mean HKA of the joint replacement group reached 176.0±2.8 degrees at one year postoperatively. The HKA of the osteotomy group improved to 177 and to 175 degrees at one year postoperatively. The average preoperative knee ROM improved significantly from 71 ± 16 degrees preoperatively to 11

关 键 词：股骨骨折 骨关节炎 关节成形术 置换 膝 

分 类 号：R687.3[医药卫生—骨科学]