保留一定内翻的全膝关节置换术治疗中度膝内翻的疗效分析  

Analysis of the efficacy of total knee arthroplasty with partial varus retention in the treatment of moderate knee varus

作　　者：鲍星安 陈有泉 周皓 杨辉 黄易 范卫民[1] 刘锋[1] Bao Xing'an;Chen Youquan;Zhou Hao;Yang Hui;Huang Yi;Fan Weimin;Liu Feng(Department of Orthopaedics,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院骨科,南京210029

出　　处：《中华骨科杂志》2025年第6期327-334,共8页Chinese Journal of Orthopaedics

摘　　要：目的探讨中度膝内翻患者全膝关节置换术(total knee arthroplasty,TKA)中保留一定内翻对疗效的影响。方法回顾性分析2010年1月至2019年10月于南京医科大学第一附属医院接受TKA治疗的613例伴有中度膝内翻的骨关节炎患者资料。根据手术计划是否保留2°~3°膝内翻分为保留内翻组和机械轴对线组。保留内翻组318例,男63例、女255例,年龄(68.51±6.95)岁(范围46~86岁),体质指数(26.99±3.66)kg/m 2(范围17.40~39.01 kg/m 2),膝关节骨关节炎Kellgren-Lawrence(K-L)分级:Ⅲ级113例、Ⅳ级205例。机械轴对线组295例,男75例、女220例,年龄(69.60±7.12)岁(范围52~87岁),体质指数(26.95±3.94)kg/m 2(范围16.60~41.90 kg/m 2),膝关节骨关节炎K-L分级:Ⅲ级102例、Ⅳ级193例。记录手术时间、总出血量、手术前后内翻角度、术后第5天下肢肿胀程度及并发症发生情况。术后3个月、6个月、1年及5年随访,评估膝关节疼痛视觉模拟评分(visual analogue score,VAS)、美国特种外科医院(Hospital for Special Surgery,HSS)评分、关节置换术后遗忘关节评分(forgotten joint score,FJS-12)、SF-36生活质量调查表(the MOS item short from health survey,SF-36)。结果613例患者均获得随访,随访时间(5.25±1.02)年(范围5.0~6.0年)。两组患者性别、年龄、体质指数、K-L分级的差异均无统计学意义(P>0.05)。两组术后内翻角度、VAS评分、HSS评分与术前相比差异均有统计学意义(P<0.05)。保留内翻组的手术时间为(77.40±18.55)min、总出血量为(920.78±407.26)ml、术后第5天下肢肿胀程度为(1.18±0.51)cm,小于机械轴对线组的(85.31±22.15)min、(1127.14±580.08)ml、(3.22±0.52)cm,差异均有统计学意义(P<0.05)。保留内翻组术后第5天、3个月的VAS评分分别为(5.08±0.72)分、(2.18±1.09)分,小于机械轴对线组的(5.80±0.81)分、(3.00±1.04)分,差异均有统计学意义(P<0.05),两组患者术后6个月、1年、5年VAS评分的差异无统计学意义ObjectiveTo analyze the efficacy of total knee arthroplasty(TKA)with partial varus retention in the treatment of moderate knee varus.MethodsA retrospective analysis was conducted on the data of 613 osteoarthritis patients with moderate knee varus who underwent TKA at the First Affiliated Hospital of Nanjing Medical University from January 2010 to October 2019.According to whether a 2°-3°of knee varus was retained,the patients were divided into the retained varus group and the mechanical alignment group.The retained varus group included 318 cases,with 63 males and 255 females,aged 68.51±6.95 years(range,46-86 years),and BMI of 26.99±3.66 kg/m 2(range,17.40-39.01 kg/m 2).Preoperative Kellgren-Lawrence(K-L)classification of knee osteoarthritis was grade III in 113 cases and grade IV in 205 cases.The mechanical alignment group included 295 cases,with 75 males and 220 females,aged 69.60±7.12 years(range,52-87 years),and BMI of 26.95±3.94 kg/m 2(range,16.60-41.90 kg/m 2).Preoperative K-L classification was grade III in 102 cases and grade IV in 193 cases.Surgical duration,total blood loss,preoperative and postoperative varus angle,lower limb swelling on the fifth postoperative day,and postoperative complications were recorded.Follow-up were arranged at 3 months,6 months,1 year,and 5 years postoperatively.At each follow-up point,the visual analogue score(VAS)for knee pain,Hospital for Special Surgery(HSS)score,Forgotten Joint Score(FJS-12),and MOS item short-form health survey(SF-36)were assessed.ResultsAll 613 patients were successfully followed up,with a follow-up period of 5.25±1.02 years(range,5.0-6.0 years).There were no statistically significant differences in gender,age,BMI,and K-L classification between the two groups(P>0.05).The differences in postoperative varus angle,VAS scores,and HSS score were statistically significant from the preoperative values in both groups(P<0.05).The surgical duration of the retained varus group was 77.40±18.55 min,total blood loss was 920.78±407.26 ml,and lower limb swelli

关 键 词：骨关节炎 膝 关节成形术 置换 膝 膝内翻 治疗结果 

分 类 号：R687.4[医药卫生—骨科学]