全膝关节置换术中股骨外侧髁滑移截骨矫正固定性膝外翻畸形的疗效观察  

Effectiveness of Sliding Osteotomy of Lateral Femur Condyle for Correcting Fixed Valgus Deformity in Total Knee Arthroplasty

作　　者：潘文杰[1] 贺艳[2] 黄袁迟 马建兵[1] 肖琳[1] Pan Wenjie;He Yan;Huang Yuanchi;Ma Jianbing;Xiao Lin(Department of Bone and Joint Surgery,Xi’an Honghui Hospital,Medical College,Xi’an JiaoTong University,Xi’an 710054,China;Xi’an NO.4 Hospital,Xi’an 710004,China)

机构地区：[1]西安交通大学医学院附属红会医院关节外科膝关节病区,陕西西安710054 [2]西安市第四医院,陕西西安710004

出　　处：《实用骨科杂志》2022年第5期401-405,共5页Journal of Practical Orthopaedics

基　　金：陕西省自然科学基金项目(2017JM8167)。

摘　　要：目的探讨初次人工全膝关节置换术(total knee arthroplasty,TKA)中股骨外侧髁滑移截骨矫正固定性膝外翻畸形的临床疗效。方法回顾性研究西安交通大学医学院附属红会医院2017年5月至2020年6月收治的15例17膝固定性外翻畸形并行初次TKA的患者资料,其中男5例5膝,女10例12膝;年龄59~76岁,平均69.5岁;体重64.5~89.0 kg,平均73.6 kg;身高156~178 cm,平均170.5 cm;骨关节炎13例15膝,类风湿性关节炎2例2膝;根据Krackow膝外翻分型标准均为Ⅱ型。置换术中采用股骨外侧髁滑移截骨恢复软组织平衡,矫正膝外翻畸形。所有患者假体选用后稳定型假体(posterior stabilized,PS)。评估术前术后影像学参数和临床结果。结果平均随访30.5个月(3~50个月)。髋膝踝角(hip knee ankle,HKA)从术前的(199.5±3.3)°矫正至术后(172.4±1.5)°,P<0.05;股骨机械轴与通髁线夹角(femoral transepicondylar angle,FTEA)明显改善,从术前的(80.3±1.7)°改善至术后(89.5±1.5)°,P<0.05。美国膝关节协会评分(American knee society score,KSS)临床评分从术前的(33.2±6.5)分改善至术后(89.1±1.2)分,功能评分从术前的(41.9±7.5)分改善至术后(82.3±5.1)分,关节活动度(range of motion,ROM)从术前的(62.0±10.1)°增加至术后(115.0±10.7)°,差异均有统计学意义(P<0.05)。术后末次随访复查影像学示假体位置均良好,截骨部位骨性愈合,无髌骨脱位,无明显内外侧不稳。结论初次人工全膝关节置换术中采用股骨外侧髁滑移截骨矫正固定性膝外翻畸形是安全、有效的,能够恢复下肢力线,平衡软组织,临床疗效满意。Objective To observe the clinical effect of sliding osteotomy of lateral femur condyle for correcting fixed valgus deformity in primary total knee arthroplasty(TKA).Methods From May 2017 to June 2020,15 patients(17 knees)with Fixed valgus knees deformity including 5 men(5 knees)and 10 women(12 knees)underwent primary total knee arthmplasty.Average age was 69.5 years(range 59~76 years).The average weight was 73.6 kg(range 64.5~89.0 kg)and average body height was 170.5 cm(range 156~178 cm).The diagnoses of the patients were osteoarthritis in 13 cases(15 knees)and rheumatoid arthritis in 2 cases(2 knees).All patients were rated as typeⅡaccording to Krackow classification of valgus knee.During primary TKA,sliding osteotomy lateral femoral condyle for restoring soft tissue balance and correcting valgus deformity were performed via a medial parapatellar approach.Posterior stabilized prosthesis was employed in all cases.Properative and postoperative imaging parameters and clinical outcomes were evaluated.Results Average follow-up was 30.5 months(range 3~50 months).The tibiofemoral angle was corrected from preoperative(199.5±3.3)°to postoperative(172.4±1.5)°(P<0.05).The femoral transepicondylar angle(FTEA)was significant improved from preoperative(80.3±1.7)°to postoperative(89.5±1.5)°(P<0.05).According to knee society score(KSS)criterion.The clinical score improved from preoperative(33.2±6.5)to postoperative(89.1±1.2)and the functional score improved from(41.9±7.5)to(82.3±5.1),the range of movement increased from preoperative(62.0±10.1)°before surgery to postoperative(115.0±10.7)°.There was significant statistic difference(P<0.05).At the last follow-up,the X-ray showed that the position of the prosthesis was good,patella dislocation was not detected and complete union was found at the osteotomy site.The clinical mediolateral instability was not detected.Conclusion Sliding osteotomy of lateral femur condyle is safe and effective for correcting fixed valgus deformity in primary TKA.Restoration of lower li

关 键 词：膝 外翻 畸形 全膝关节置换 滑移截骨 

分 类 号：R687.42[医药卫生—骨科学]