高度膝关节外翻畸形人工膝关节置换术合并症的预防

Complication prevention in total knee arthroplasty with severe valgus deformity

目的探讨预防高度膝关节外翻畸形人工膝关节置换术出现合并症的手术方法和技巧。方法21例高度膝关节外翻畸形患者,应用膝关节髌骨外侧手术入路Z形切开,假体安放旋转定位,以膝关节周围韧带平衡后下肢力线为基准。膝关节外翻的软组织平衡方法:膝关节屈曲位和伸直位外侧间隙均紧张,在屈曲膝关节90°状态位,松解股骨外髁上外侧副韧带、关节囊后外侧角、腘肌腱;伸直位网格状松解髂胫束上方。屈曲位良好而伸直位紧张,松解髂胫束、外侧副韧带、后关节囊;屈曲位紧张伸直位良好,松解腘肌腱、外侧副韧带、关节囊后外侧角。结果21例均获随访,时间9～28个月,2例迟发腓总神经麻痹,3个月后恢复。手术切口一期愈合。KSS评分术前为(43.3±4.1)分,术后12个月为(83.8±5.2)分,24个月为(87.4±4.5)分。结论应用人工膝关节置换手术治疗高度外翻膝关节畸形,难于膝关节内翻,采用膝关节外侧手术入路和相应设计的手术方法,能够很好解决外翻膝关节人工关节置换手术出现的合并症。

Objective To study the operation method to prevent complication in total knee arthroplasty （TKA） with severe valgus deformity. Methods 21 patients with severe valgus deformities were undergone TKA. The operations were done through lateral ＂Z＂ shape incisions. Prosthesis rotation positioning and soft tissue balancing were done, and the lower leg alignments were restored. When soft tissue was tight both in flexion and extension, releasing was done with 90° flexion in upper lateral collateral ligament of lateral condyle, articular capsule angulus posteriolateralis and popliteal tendon, and with extension in upper iliotibial tract in grid form. When soft tissue was fine in flexion and tight in extension, releasing was done in iliotibial track, lateral collateral ligment and posterior capsule; When soft tissue was tight in flexion and fine in extension, releasing was done in popliteal tendon, lateral collateral ligament and angulus posteriolateralis of the articular capsule. Results 21 cases were followed up for 9 - 28 months, averaged 26. 7 months. Among them, 2 cases had late onset peroneal nerve palsy, and recovered after 3 month. Operative incision got primary healing. Preoperative KSS score was （43.3 ±4. 1 ） points, and was restored to（83.8±5.2） points in 12 months, and （87.4 ±4.5） points in 24 months. Conclusions It is more difficult to perform TKA with valgus than varus. Lateral approach and the operation is beneficial for prevention of complication.