髌旁内外侧入路全膝关节置换治疗中重度外翻膝  

Moderate and severe valgus knee by total knee arthroplasty through medial and lateral parapatellar approach

作　　者：王体惠 王旭 吴锦清 陈继良 王启金 许宏伟 林建国 Wang Tihui;Wang Xu;Wu Jinqing;Chen Jiliang;Wang Qijin;Xu Hongwei;Lin Jianguo(Department of Joint Surgery,Mindong Hospital Affiliated to Fujian Medical University,Fuan 355000,Fujian Province,China)

机构地区：[1]福建医科大学附属闽东医院关节外科,福建省福安市355000

出　　处：《中国组织工程研究》2024年第30期4825-4830,共6页Chinese Journal of Tissue Engineering Research

基　　金：福建省自然科学基金经费支持(2019J01618),项目负责人:王体惠。

摘　　要：背景:中重度外翻膝全膝关节置换术中仍有假体限制性选择、软组织松解、髌骨轨迹恢复及骨缺损重建等关键问题需要优化,髌旁内侧入路治疗外翻膝存在加剧内侧软组织松弛等缺点,近年来发现髌旁外侧入路治疗外翻膝中具有显露及松解等优点。目的:观察髌旁内外侧入路全膝关节置换应用于中重度外翻膝的疗效,旨在探讨更加适合中重度外翻膝的手术入路。方法:选择56例中重度外翻膝行全膝关节置换的患者,按照患者入院先后顺序轮流进行髌旁内、外侧入路手术,外侧组28例行髌旁外侧入路全膝关节置换,内侧组28例行髌旁内侧入路全膝关节置换,所有患者均使用后稳定型膝关节假体。收集两组患者术中假体限制性种类、聚乙烯衬垫厚度、手术时间、出血量、股胫角、髌骨倾斜角、活动度、纽约特种外科医院评分、西安大略省和麦克马斯特大学骨关节炎指数评分及并发症作为观察指标并进行统计分析。结果与结论:①外侧组髁限制性假体使用率明显低于内侧组,聚乙烯衬垫平均厚度低于内侧组,手术时间更短,两组比较差异有显著性意义(P<0.05);手术出血量两组之间无显著性差异;②56例患者随访2-5年,所有患者无假体松动及骨吸收迹象;末次随访外侧组髌骨倾斜角及胫股角小于内侧组,纽约特种外科医院评分及西安大略省和麦克马斯特大学骨关节炎指数评分高于外侧组,差异有显著性意义(P<0.05);两组膝关节活动度无显著性差异;③两组各有1例患者切口脂肪液化及小腿肌间静脉血栓形成;随访期间未发生感染、切口愈合不良、切口血肿、假体脱位、医源性神经损伤、异位骨化、假体周围骨折等情况;④提示髌旁外侧入路治疗中重度外翻膝可有效保护膝内侧软组织张力,更少使用髁限制性假体,髌骨轨迹更加友好,术后功能评分更高。BACKGROUND:Prosthesis restricted selection,soft tissue release,patellar trajectory recovery,and bone defect reconstruction were need to be optimized in total knee arthroplasty for moderate and severe valgus knee.The medial parapatellar approach has disadvantages in the treatment of valgus knee,such as aggravating the medial soft tissue relaxation.In recent years,it has been found that the lateral parapatellar approach has advantages in the treatment of valgus knee,such as exposure and release.OBJECTIVE:To observe the efficacy of the lateral and medial parapatellar approach in total knee arthroplasty for moderate and severe valgus knee,and to explore a more suitable surgical approach for moderate and severe valgus knee.METHODS:Totally 56 patients with moderate and severe valgus knee underwent total knee arthroplasty and would take turns performing surgery through the medial and lateral parapatellar approach according to the order of admission.The lateral group(n=28)underwent total knee arthroplasty through lateral parapatellar approach,and the medial group(n=28)through medial parapatellar approach.Posterior stablized knee prosthesis was used in all patients.The restricted types of prosthesis,thickness of polyethylene,operation time,amount of blood loss,femoro-tibia angle,patellar tilt angle,range of motion,Hospital for Special Surgery score,Western Ontario and McMaster Universities Arthritis Index(WOMAC)score,and complications were collected as observation indexes for statistical analysis.RESULTS AND CONCLUSION:(1)The utilization rate of condyle-restricted prosthesis in the lateral group was significantly lower than that in the medial group.The average thickness of polyethylene liner was lower,and the operation time was shorter in the lateral group compared with the medial group.There were significant differences between the two groups(P<0.05),and there was no significant difference in the amount of surgical bleeding.(2)56 patients were followed up for an average of 2-5 years.There were no signs of prosthesis loos

关 键 词：中重度外翻膝 膝关节 髌旁外侧入路 全膝关节置换 软组织平衡 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R687.4