单髁置换术前后对膝内翻畸形患者踝关节的影响研究  

Effect of Knee Varus Deformity on the Ankle before and after Unicompartmental Knee Arthroplasty

作　　者：叶修业 吴子光 李纯 徐彬彬 唐剑邦 郑炜宏 何君源 Ye Xiuye;Wu Ziguang;Li Chun;Xu Binbin;Tang Jianbang;Zheng Weihong;He Junyuan(Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine,Zhongshan 528400,China)

机构地区：[1]广州中医药大学附属中山中医院,广东中山528400

出　　处：《实用骨科杂志》2024年第10期884-889,共6页Journal of Practical Orthopaedics

基　　金：中山市社会公益与基础研究专项(卫生重点项目)(2020B3008)。

摘　　要：目的评估术前膝内翻畸形患者下肢力线与踝关节在冠状位上对位不良与对线不良之间的相关性及行膝关节单髁置换术(unicompartmental knee arthroplasty,UKA)后踝关节冠状位排列的变化。方法选取2021—2022年行UKA术并符合纳入标准的42例患者,其中男5例,女37例;年龄49~73岁,平均(61.45±6.60)岁。对患者术前和术后末次随访的双下肢站立负重位全长DR片上膝和踝关节的力线、角度进行测量。所测角度有髋-膝-踝关节角(the hip-knee-ankle angle,HKA)、胫骨近端内侧角(medial proximal tibial,MPTA)、胫距角(tibial anterior surface,TAS)、胫骨平台倾角(tibial plafond inclination,TPI)、距骨倾角(talar inclination,TI)和胫距倾斜角(tibiotalar tilt,TT)。结果患者术后随访10~14个月,平均(12.3±1.7)个月。膝内翻畸形的平均矫正角度为(5.34±2.61)°;MPTA由术前的平均(83.41±1.44)°变为平均(88.06±0.93)°;TAS由术前的平均(89.14±4.12)°变为平均(87.92±3.87)°;TPI和TI分别由术前的93.08°和91.58°变为89.38°和88.86°,差异有统计学意义(P<0.05)。术前HKA与MPTA、TPI、TI之间存在显著相关性,差异有统计学意义(P<0.05),表明术前膝内翻畸形可影响远端踝关节倾斜;术后末次HKA与MPTA、TPI之间存在显著相关性,差异有统计学意义(P<0.05),表明UKA术后踝关节的倾斜及对位不良随着下肢力线的纠正发生变化。结论踝关节对线及对位在一定程度上受膝内翻畸形影响,通过UKA对膝内翻畸形的矫正,可对远端踝关节对位及对线不良进行改善,对维持踝关节稳定具有积极影响。Objective To evaluate the correlation between force alignment and ankle coronal alignment in preoperative knee varus deformity,as well as the alteration in ankle coronal alignment subsequent to unicompartmental knee arthroplasty(UKA)among patients with knee varus deformity.Methods 42 patients who underwent UKA between 2021 and 2022 were selected,including 5 males and 37 females,aged 49~73 years,mean age(61.45±6.60)years.The force lines and angles of the upper knee and ankle joint were measured on full-length DR films of both lower limbs(in weight-bearing position)before and after the surgery.The angles measured encompassed the hip-knee-ankle angle(HKA),medial proximal tibial angle(MPTA),tibial anterior surface angle(TAS),tibial plateau inclination(TPI),talar inclination(TI),and tibiotalar tilt(TT).Results All 42 patients were followed 10~14 months,with an average of(12.3±1.7)months.The average correction angle of knee varus deformity was(5.34±2.61)°.The MPTA changed from(83.41±1.44)°before operation to(88.06±0.93)°after;TAS changed from(89.14±4.12)°to 8(7.92±3.87)°;and TPI and TI changed from 93.08°and 91.58°to 89.38°and 88.86°,respectively(P<0.05).There was a significant correlation between HKA and MPTA,TPI,TI before operation(P<0.05),suggesting that knee varus deformity affects the tilt of the distal ankle joint preoperatively.Additionally,there was a significant correlation between HKA,MPTA,and TPI after UKA(P<0.05),indicating that ankle tilt and misalignment changed with the correction of the lower limb force line post-UKA.Conclusion The alignment of the ankle joint is affected to a certain extent by knee varus deformity.UKA can improve the malalignment and alignment of the distal ankle joint by correcting knee varus deformity,which has a positive impact on maintaining the stability of the ankle joint.

关 键 词：骨关节炎 单髁置换术 踝关节 膝内翻畸形 矫正 

分 类 号：R684.3[医药卫生—骨科学]