拉花松解技术在关节外内翻畸形全膝置换术的应用

Application of pie-crusting technique to varus knee during total knee arthroplasty

目的探索在关节外膝内翻畸形全膝关节置换术(TKA)中应用拉花松解技术(pie-crusting)可矫正的内翻程度并评估疗效。方法本研究回顾2018年11月至2020年6月在赤峰市医院收治的内翻膝TKA中应用pie-crusting技术40例,测量股骨远端机械外侧角(mLDFA)、胫骨近端机械内侧角(MPTA)、关节线相交角(JLCA)、机械轴偏向(MAD)、关节内外整体内翻角[180°减去髋-膝-踝角(HKA)],评估内翻来源、内翻程度、下肢力线。比较手术前后美国特种外科医院(HSS)膝关节评分、疼痛视觉模拟量表(VAS)评分、膝关节活动度(ROM),采用配对样本t检验和Wilcoxon符号秩和检验评估疗效。结果本组TKA中应用pie-crusting技术40例均伴有膝关节内翻畸形,术前mLDFA(92.7±3.1)°;MPTA(74.7±2.6)°;关节内外整体内翻角(23.1±3.5)°。比较手术前后HSS评分(t=-93.4)、VAS评分(Z=-5.57)、ROM(t=-37.1)、MAD(t=64.8)差异均有统计学意义(均为P<0.05)。结论内翻膝TKA中应用pie-crusting技术,关节内外整体内翻角<29°可应用该技术恢复关节平衡和下肢力线,关节外畸形在关节内矫正,疗效确切且安全。

Objective To investigate the correctable degree and source of varus deformity utilizing the pie-crusting technique in total knee arthroplasty(TKA)of knees with varus deformity,and evaluate its efficacy.MethodsA total of 40 patients with varus knee deformity treated by pie-crusting technique during TKA at the Chifeng Municipal Hospital from November 2018 to June 2020 were retrospectively analysed.The mechanical lateral distal femoral angle(mLDFA),medial proximal tibial angle(MPTA),joint line convergence angle(JLCA),mechanical axis deviation(MAD)and 180°minus hip-knee-ankle(HKA)angle were measured before operation.The degree and source of deformity,and the restoration of the lower limb force line were assessed.Paired-samplesttest andWilcoxon signed-ranktest were conducted to compare changes in the Hospital for Special Surgery(HSS)score,visual analogue scale(VAS)and knee joint range of motion(ROM)before and after surgery.ResultsAll the patients subjected to pie-crusting technique treatments in TKA were accompanied by extra-articular varus deformity.The pre-operative mLDFA,MPTA and knee varus angle were(92.7±3.1)°,(74.7±2.6)°and(23.1±3.5)°respectively.The HSS score(t=-93.4),VAS score(Z=5.57),knee ROM(t=-37.1)and MAD(t=64.8)were improved when compared with preoperative ones(allP<0.05).ConclusionWhen the global knee varus angle is less than 29°,pie-crusting technique can be used in TKA to regain the joint balance and the lower limb mechanical alignment line efficiently and safely;the extra-articular deformities may be corrected intra-articularly.