股内侧肌下入路全膝关节置换治疗膝外翻畸形的中长期随访  

Mid-and long-term follow-up of valgus knees with total knee arthroplasty via subvastus approach

作　　者：刘洪文 尹立[3] 徐文豪 李皎 罗奋棋[2] 刘绍江[1] 徐杰[2] Liu Hongwen;Yin Li;Xu Wenhao;Li Jiao;Luo Fenqi;Liu Shaojiang;Xu Jie(Department of Orthopedics,Panzhihua Central Hospital,Panzhihua 617000,Sichuan Province,China;Department of Orthopedics,Fujian Provincial Hospital,Fujian Medical University,Fuzhou 350001,Fujian Province,China;Department of Discipline Construction Office,Panzhihua Central Hospital,Panzhihua 617000,Sichuan Province,China)

机构地区：[1]攀枝花市中心医院骨科,四川省攀枝花市617000 [2]福建医科大学省立临床医学院,福建省立医院骨科,福建省福州市350001 [3]攀枝花市中心医院学科建设办公室,四川省攀枝花市617000

出　　处：《中国组织工程研究》2023年第13期2033-2037,共5页Chinese Journal of Tissue Engineering Research

基　　金：四川省中管局中医药科研专项课题(2020JC0087),项目负责人:尹立;成都中医药大学学科人才科研专项课题(YYZX20211097),项目负责人:刘洪文;福建省自然科学基金面上项目(2019J01173),项目负责人:徐杰。

摘　　要：背景:股内侧肌下入路是全膝关节置换最微创的一种手术方式,患者术后膝关节功能恢复快,但长期疗效不清楚。目的:观察股内侧肌下入路全膝关节置换治疗膝外翻畸形中长期的假体位置和膝关节功能情况。方法:回顾性分析2009年1月至2018年1月福建省立医院骨科收治的膝外翻畸形患者50例共55膝,采用股内侧肌下入路、股骨外翻3°-5°截骨、常规置换髌骨。统计手术时间、显性出血量、切口长度、起始下地时间、起始上下楼梯时间和住院天数等一般资料;采用目测类比评分、膝关节协会功能评分、纽约特种外科医院评分、膝关节屈伸活动度、胫股角、髋-膝-踝角、髁-髋角、平台-踝角等指标评价术后疗效和假体在位情况。结果与结论:①随访时间为4.7-11.1年;②手术时间(67.2±6.2)min,显性出血量(317.3±109.6)mL,切口长度(11.5±1.2)cm,起始下地时间(1.1±0.5)d,起始上下楼梯时间(2.3±0.9)d,住院天数(4.9±1.2)d;③与术前相比,末次随访时患者目测类比评分显著降低、膝关节活动度、膝关节协会功能评分、纽约特种外科医院评分均显著增加,胫股角/髋-膝-踝角显著降低,髁-髋角/平台-踝角显著降低,差异均有显著性意义(P<0.001);④术后均未发生腓总神经麻痹、感染、深静脉栓塞等并发症,随访期间假体位置良好,无翻修病例;⑤提示股内侧肌下入路全膝关节置换治疗膝外翻畸形,中长期假体位置、下肢力线良好,功能恢复满意。BACKGROUND:The subvastus approach is the most minimally invasive surgical method for total knee arthroplasty.The knee joint function recovers quickly after surgery,but the long-term efficacy is unclear.OBJECTIVE:To evaluate the mid-and long-term prosthesis position and knee function of valgus knees with total knee arthroplasty via subvastus approach.METHODS:A retrospective investigation was conducted among 50 patients(55 knees)with valgus knees in the Department of Orthopedics,Fujian Provincial Hospital from January 2009 to January 2018.Total knee arthroplasty was performed via subvastus approach,femoral distal resection with 3°to 5°of valgus,and the routinely resurfaced patella.The operation time,blood loss,incision length,grounding time,time up and downstairs,and hospital stay were recorded.Visual analogue scale,Knee Society Score,hospital for special surgery,range of motion,femorotibial angle,hip-knee-ankle angle,condylar-hip angle,and plateau-ankle angle were counted to assess postoperative efficacy and prosthesis position.RESULTS AND CONCLUSION:(1)Follow-up time was 5.7-11.1 years.(2)The operation time was(67.2±6.2)minutes;blood loss was(317.3±109.6)mL;incision length was(11.5±1.2)cm;grounding time was(1.1±0.5)days;time of up and down stairs was(2.3±0.9)days;hospital stay was(4.9±1.2)days.(3)Compared with preoperative data,visual analogue scale scores decreased significantly.Range of motion,Knee Society Score,and hospital for special surgery score increased significantly at the last follow-up.Femorotibial angle/hip-knee-ankle angle decreased significantly.Condylar-hip angle and plateau-ankle angle decreased significantly(P<0.001).(4)No postoperative complications such as common peroneal nerve palsy,infection or deep venous embolism occurred.During the follow-up,the prosthesis was in a good position and no revision cases were performed.(5)It is indicated that total knee arthroplasty via subvastus approach for valgus knees can get satisfactory mid-and long-term prosthesis position,lower limb alignment,

关 键 词：股内侧肌下入路 关节成形术 膝外翻 假体位置 临床疗效 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R687