多针穿刺内侧韧带技术在全膝关节置换术中纠正膝内翻的疗效和安全性分析  

Efficacy and safety of functional medial ligament balancing with multiple needle puncturing in varus total knee arthroplasty

作　　者：蔡文翔 彭昊[1] CAI Wenxiang;PENG Hao(Dept.of Orthopedics,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China)

机构地区：[1]武汉大学人民医院骨科,湖北武汉430060

出　　处：《武汉大学学报（医学版）》2024年第3期329-334,共6页Medical Journal of Wuhan University

基　　金：国家自然科学基金资助项目(编号:81672154);湖北省重点研发计划项目(编号:2021BCA147)。

摘　　要：目的:评价膝内翻患者全膝关节置换术(TKA)中进行多针穿刺(MNP)松解内侧副韧带的临床效果。方法:对2018年6月至2020年6月因膝内翻骨性关节炎行TKA治疗的120例患者的临床资料进行回顾性研究。其中,男性27例,女性93例;年龄66~86岁,平均年龄72岁。按患者术中是否采用多针穿刺松解内侧副韧带分为MNP组和对照组,其中MNP组58例,对照组62例。进行定期随访,记录两组患者术前及术后6月、1年随访时的关节活动度(ROM)、WOMAC指数评分、HSS评分、髋膝踝角(HKA)、内外翻应力位角度、AKSS活动及功能评分。结果:120例患者均按计划获得随访,平均时间为(16.4±6.7)月。术前HKA显示MNP组(9.75±3.08)°与对照组(8.31±2.80)°有差异(P=0.009);术前内外翻应力位角度差显示MNP组和对照组之间有差异(Z=-2.119,P=0.034)。TKA术后随访显示MNP组与对照组的ROM、WOMAC指数评分、HSS评分、内外翻应力位角度及角度差、HKA、AKSS活动和功能评分较术前均明显改善,而MNP组与对照组组间比较无明显差异。结论:MNP治疗内翻性骨性关节炎是一种有效、可重复且安全的方法。MNP技术可以逐渐延长内侧软组织,而没有过度延长或内侧副韧带断裂的风险,同时也不会影响患者术后膝关节功能及活动度。Objective:To evaluate the clinical effect of multiple needle puncture(MNP)release of medial collateral ligament in varus total knee arthroplasty(TKA)for patients.Methods:The clinical data of 120 patients with varus knee osteoarthritis who underwent TKA from June 2018 to June 2020 were retrospectively studied.There were 27 males and 93 females.The age ranged from 66 to 86 years,with an average age of 72 years.The patients were divided into the MNP group(n=58)and control group(n=62)according to whether the medial collateral ligament was released by multiple needle punctures during operation.The joint range of motion(ROM),HSS score,hip knee ankle angle(HKA),varus and valgus stress angle,and AKSS activity and function score were recorded before the operation and at 1⁃year follow⁃up.Results:All 120 patients were followed up as planned,with an average time of(16.4±6.7)months.The preoperative HKA of the MNP group(9.75±3.08)°was significantly different from that of the control group(8.31±2.80)°(P=0.009).The preoperative dif⁃ference in the varus⁃valgus stress angle of the MNP group was significantly different from that of the control group(Z=-2.119,P=0.034).After TKA,the ROM,WOMAC score,HSS score,varus stress angle,valgus stress angle,the difference in varus⁃valgus stress angle,HKA,and AKSS activi⁃ty and function score were significantly improved in both groups,while no significant difference was found between the two groups.Conclusion:MNP is an effective,reproducible,and safe method for the treatment of varus osteoarthritis.We believe that the MNP technique can gradually lengthen the medial soft tissue without the risk of excessive lengthening or medial collateral ligament(MCL)rup⁃ture and without compromising the postoperative knee function and range of motion.

关 键 词：全膝关节置换 膝内翻 软组织平衡 多针穿刺 疗效 

分 类 号：R686.5[医药卫生—骨科学]