全膝关节置换治疗膝外翻畸形的疗效观察
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摘要
目的探讨全膝关节置换术治疗成年膝外翻畸形患者的手术技巧和疗效观察。方法 2015年1月至2017年5月本院收治的膝外翻畸形38例共40膝,年龄46～73(61±4.2)岁。胫股角(FTA)7°～35°(11°±4.3°),患侧膝关节平均活动度为80°～110°(93°±17°),美国特种外科医院(HSS)评分为21～65(43±8.6)分。行全膝关节置换术纠正畸形,改善功能。结果所有患者均获得随访,时间为6个月至3年。患者均无明显的膝关节疼痛或功能障碍。术后FTA1°～7°(4°±3°);患侧膝关节平均活动度为115°±10°;HSS评分(76±14)分;与术前比较差异均有统计学意义(P<0.05)。结论全膝关节置换术是治疗成年膝外翻畸形的常规方法,术中选择合理的入路,准确的截骨,恰当的软组织松解,能获得满意的关节功能和临床疗效。
Objective To discuss the surgical technique and effectiveness of total knee arthroplasty(TKA) for the valgus knee in adult. Methods Retrospective analysis the clinical data from 2015 January to 2017 May of 38 patients with 40 knees treated in our hospital. Age 46-73(61±4. 2) years old. The femur-tibia angle(FTA) was 7°-35°(11° ±4. 3°),the average range of motion(ROM) was 115°± 10°,the Hospital for Special Surgery(HSS) score was 21-65(43 ±8.6). All cases were corrected deformity and improved function by TKA. Results 38 patients were followed up 6 months to 3 years. All patients had no severe pain and dysfunction. The postoperative FTA was 1°-7°(4 ±3°),the average ROM was 115°±10°,the HSS score was 76 ± 14,showing significant difference compared with preoperative data(P <0. 05). Conclusions The TKA is a conventional therapy for valgus deformed knee in adult. By appropriate approach, precise osteotomy, accurate soft tissue balance, satisfactory joint function and effectiveness can be achieved.
Objective To discuss the surgical technique and effectiveness of total knee arthroplasty(TKA) for the valgus knee in adult. Methods Retrospective analysis the clinical data from 2015 January to 2017 May of 38 patients with 40 knees treated in our hospital. Age 46-73(61±4. 2) years old. The femur-tibia angle(FTA) was 7°-35°(11° ±4. 3°),the average range of motion(ROM) was 115°± 10°,the Hospital for Special Surgery(HSS) score was 21-65(43 ±8.6). All cases were corrected deformity and improved function by TKA. Results 38 patients were followed up 6 months to 3 years. All patients had no severe pain and dysfunction. The postoperative FTA was 1°-7°(4 ±3°),the average ROM was 115°±10°,the HSS score was 76 ± 14,showing significant difference compared with preoperative data(P <0. 05). Conclusions The TKA is a conventional therapy for valgus deformed knee in adult. By appropriate approach, precise osteotomy, accurate soft tissue balance, satisfactory joint function and effectiveness can be achieved.
引文
[1]Mullaji AB,Shetty GM,Kanna R,et al.The influence of preoperative deformity on valgus correction angle:an analysis of 503 total knee arthroplasties[J].J Arthroplasty,2013,28(1):20-27.DOI:10.1016/j.arth.2012.04.014.
[2]Mullaji AB,Shetty GM,Lingaraju AP,et al.Which factors increase risk of malalignment of the hip-knee-ankle axis in TKA?[J].Clin Orthop Relat Res,2013,471(1):134-141.DOI:10.1007/s11999-012-2520-3.
[3]Ranawat AS,Ranawat CS,Elkus M,et al.Total knee arthroplasty for severe valgus deformity[J]J Bone Joint Surg Am,2005,87Suppl 1(Pt 2):271-284.DOI:10.2106/JBJS.E.00308.
[4]Keblish PA.The lateral approach to the valgus knee.Surgical technique and analysis of 53 cases with over two-year follow-up evaluation[J].Clin Orthop Relat Res,1991,(271):52-62.
[5]Sekiya H,Takatoku K,Takada H,et al.Lateral approach is advantageous in total knee athroplasty for valgus deformed knee[J].Eur J Orthop Surg Traumatol,2014,24(1):111-115.
[6]Rossi R,Rosso F,Cottino U,et al.Total knee arthroplasty in the valgus knee[J].International orthopaedics,2014,38(2):273-283.
[7]Zhou K,Zhou Z,Chen Z,et al.INDIVIDUAL ANGLE VERSUS FIXED ANGLE DISTAL FEMORAL VALGUS RESECTION IN SUBJECTS WITH VALGUS DEFORMITY UNDERGOING PRIMARY TOTAL KNEE ARTHROPLASTY:A prospective randomized controlled TRIAL[J].Bone Joint J,2017,99(SUPP 6):123-123.
[8]张宪,杨镇,宋伟,等.全膝关节置换术治疗严重膝外翻的疗效观察[J].临床骨科杂志,2016,19(1):34-37.DOI:10.3969/j.issn.1008-0287.2016.01.014.
[9]Mullaji A,Shetty GM.Persistent hindfoot valgus causes lateral deviation of weightbearing axis after total knee arthroplasty[J].Clin Orthop Relat Res,2011,469(4):1154-1160.DOI:10.1007/s11999-010-1703-z.
[10]Chandler JT,Moskal JT.Evaluation of knee and hindfoot alignment before and after total knee arthroplasty:a prospective analysis[J].J Arthroplasty,2004,19(2):211-216.
[11]Whiteside LA.Selective ligament release in total knee arthroplastyof the knee in valgus[J].Clin Orthop Relat Res,1999,(367):130-140.
[12]Jia Y,Gou W,Geng L,et al.Anatomic proximity of the peroneal nerve to the posterolateral corner of the knee determined by MR imaging[J].Knee,2012,19(6):766-768.DOI:10.1016/j.knee.2012.01.007.
[13]钟航,黄强,杨静,等.人工全膝关节置换术中滑移截骨矫正重度外翻畸形的疗效观察[J].中国修复重建外科杂志,2016,30(2):143-147.
[14]Xie K,Lyons ST.Soft Tissue Releases in Total Knee Arthroplasty for Valgus Deformities[J].J Arthroplasty,2017,32(6):1814-1818.DOI:10.1016/j.arth.2017.01.024.
[15]Pagoti R,O'Brien S,Doran E,et al.Unconstrained total knee arthroplasty in significant valgus deformity:a modified surgical technique to balance the knee and avoid instability[J].Knee Surg Sports Traumatol Arthrosc,2017,25(9):2825-2834.DOI:10.1007/900167-015-3881-4.
[2]Mullaji AB,Shetty GM,Lingaraju AP,et al.Which factors increase risk of malalignment of the hip-knee-ankle axis in TKA?[J].Clin Orthop Relat Res,2013,471(1):134-141.DOI:10.1007/s11999-012-2520-3.
[3]Ranawat AS,Ranawat CS,Elkus M,et al.Total knee arthroplasty for severe valgus deformity[J]J Bone Joint Surg Am,2005,87Suppl 1(Pt 2):271-284.DOI:10.2106/JBJS.E.00308.
[4]Keblish PA.The lateral approach to the valgus knee.Surgical technique and analysis of 53 cases with over two-year follow-up evaluation[J].Clin Orthop Relat Res,1991,(271):52-62.
[5]Sekiya H,Takatoku K,Takada H,et al.Lateral approach is advantageous in total knee athroplasty for valgus deformed knee[J].Eur J Orthop Surg Traumatol,2014,24(1):111-115.
[6]Rossi R,Rosso F,Cottino U,et al.Total knee arthroplasty in the valgus knee[J].International orthopaedics,2014,38(2):273-283.
[7]Zhou K,Zhou Z,Chen Z,et al.INDIVIDUAL ANGLE VERSUS FIXED ANGLE DISTAL FEMORAL VALGUS RESECTION IN SUBJECTS WITH VALGUS DEFORMITY UNDERGOING PRIMARY TOTAL KNEE ARTHROPLASTY:A prospective randomized controlled TRIAL[J].Bone Joint J,2017,99(SUPP 6):123-123.
[8]张宪,杨镇,宋伟,等.全膝关节置换术治疗严重膝外翻的疗效观察[J].临床骨科杂志,2016,19(1):34-37.DOI:10.3969/j.issn.1008-0287.2016.01.014.
[9]Mullaji A,Shetty GM.Persistent hindfoot valgus causes lateral deviation of weightbearing axis after total knee arthroplasty[J].Clin Orthop Relat Res,2011,469(4):1154-1160.DOI:10.1007/s11999-010-1703-z.
[10]Chandler JT,Moskal JT.Evaluation of knee and hindfoot alignment before and after total knee arthroplasty:a prospective analysis[J].J Arthroplasty,2004,19(2):211-216.
[11]Whiteside LA.Selective ligament release in total knee arthroplastyof the knee in valgus[J].Clin Orthop Relat Res,1999,(367):130-140.
[12]Jia Y,Gou W,Geng L,et al.Anatomic proximity of the peroneal nerve to the posterolateral corner of the knee determined by MR imaging[J].Knee,2012,19(6):766-768.DOI:10.1016/j.knee.2012.01.007.
[13]钟航,黄强,杨静,等.人工全膝关节置换术中滑移截骨矫正重度外翻畸形的疗效观察[J].中国修复重建外科杂志,2016,30(2):143-147.
[14]Xie K,Lyons ST.Soft Tissue Releases in Total Knee Arthroplasty for Valgus Deformities[J].J Arthroplasty,2017,32(6):1814-1818.DOI:10.1016/j.arth.2017.01.024.
[15]Pagoti R,O'Brien S,Doran E,et al.Unconstrained total knee arthroplasty in significant valgus deformity:a modified surgical technique to balance the knee and avoid instability[J].Knee Surg Sports Traumatol Arthrosc,2017,25(9):2825-2834.DOI:10.1007/900167-015-3881-4.