全膝关节置换术治疗合并外翻畸形的晚期膝骨关节炎的疗效评价

摘要

Objective To investigate the surgical technique and clinical effect oftotal knee arthroplasty in treatment oflateknee osteoarthritis combined with valgus knee deformity.Methods A total of 53 patients(26 males,27 females)received total knee arthroplasty for late knees osteoarthritis complicated with valgus deformitybetween February 2012 andFebruary 2014 in xi'an Honghui hospital.We adopted a stable prosthesissurgery through the knee midline incision,lateral patellar approach,a lateral soft tissue releasecorrecting of knee valgus deformity.Then conventional anticoagulation and early functional exercise such as flexion and extensionwere utilized.Preoperative and postoperative X-ray was conducted in patients with measuring femor-tibial angle (FTA) andparallel knee scoring system (KSS) and knee functional score were used to evaluate the clinical effect.Results 53 patients were followed up for 13 to 24 months withthetypeⅠwoundhealing,no infection and dehiscence.Preoperative FTA was 15.3 ° (10.1 ° ～ 19.3°) and postoperative FTA was 5.2° (4.3°～8.4°),knee joint's range of motion increasedfrom 72°(61 °～85°) to 98°(89°～110°).The KSS score increased from an average of 25.3points (13～39 points) preoperatively to 89.1 points (85～97 points).The knee function score increase froman average of 23.0 points (2～38 points) beforeoperation to 89.3 points (84～97 points) after operation.These improvement are all statistically significent.Conclusion Total knee arthroplastyusing the lateral patellar approach,a selective osteotomy and soft tissue release and balance technicis an effective way in treatment oflateknee osteoarthritis combined with valgus knee deformity.%目的 探讨人工全膝关节置换手术方法治疗合并外翻畸形的晚期膝骨关节炎的手术技巧及临床疗效.方法 选取西安市红会医院自2012年2月至2014年2月收治的53例合并外翻畸形的晚期膝骨关节炎患者,其中男26例,女27例,平均年龄63.4岁.采用膝前正中切口、髌旁外侧入路、外侧软组织松解、使用后方稳定型膝关节假体进行人工全膝关节置换治疗,术后给予抗凝及早期膝关节屈伸功能锻炼,术前及术后摄取X线片测量患者股胫角(fem-or-tibial angle,FTA),并使用KSS评分及膝关节功能评分来评价手术临床效果.结果 53例患者均获得随访,随访时间13～24个月,伤口均Ⅰ期愈合,无感染及裂开.术前FTA角为15.3°(10.1°～19.3°),术后为5.2°(4.3°～8.4°),膝关节活动度由术前的72°(61°～85°)提高到术后的98°(89°～110°),KSS评分由术前的平均25.3分(13～39分)提高到术后的平均89.1分(85～97分),膝关节功能评分由术前的23.0分(2～38分)提高到89.3分(84～97分),经统计学分析差异均有统计学意义(P＜0.05).结论 人工全膝关节置换术治疗合并外翻畸形的晚期膝骨关节炎,术中采用髌旁外侧入路、选择性截骨、恰当的软组织平衡方法及选择合适的人工膝关节假体,可以很好地恢复膝关节屈伸功能,疗效确切.