人工全膝关节置换术中髌股关节轨迹运行不良的纠正

CORRECTION OF MALTRACKING OF PATELLOFEMORAL JOINTS IN TOTAL KNEE ARTHROPLASTY

目的总结人工全膝关节置换(total knee arthroplasty,TKA)中,纠正髌股关节轨迹运行不良的方法。方法2000年1月-2007年5月,对48例49膝TKA中出现髌股关节轨迹运行不良患者采用平衡髌骨内外侧支持带张力、适当调整胫骨假体位置或重建髌韧带止点的方法进行纠正。患者均为女性;年龄53～76岁,平均66.8岁。病程6～23年,平均16.2年。其中骨性关节炎37例38膝,类风湿性关节炎11例11膝。患膝均有不同程度膝外翻和胫骨外旋畸形。膝外翻角为23～42°,平均33°;Q角为16～23°,平均19°。23例有8～35°屈曲畸形,平均22°。术前膝关节KSS评分21～51分,平均32分;KSS功能评分29～45分,平均33分。结果术中髌股关节运行轨迹恢复正常,髌骨未再出现向外脱位倾向。术后切口均Ⅰ期愈合,无相关并发症发生。所有患者术后均获随访,随访时间7～82个月,中位随访时间52个月。膝关节外翻畸形均获得矫正,3例残留5°左右的屈曲畸形,重建的髌韧带未出现撕裂或断裂现象。术后膝关节KSS评分为76～89分,平均82分;KSS功能评分为81～90分,平均85分。术后至随访期末X线片均显示人工关节位置正常。结论TKA中出现髌股关节轨迹运行不良时,平衡髌骨内外侧支持带张力、适当调整胫骨假体位置或重建髌韧带止点是纠正这一现象的有效方法,对膝关节的功能康复无不利影响。

Objective To summarize the strategies and treatment methods in correcting the maltracking of patellofemoral joints in the total knee arthroplasty （TKA）. Methods From January 2000 to May 2007, the methods of releasing lateral retinaculum and tightening medial retinaculum of patellar, adjusting the position of the tibial prothesis properly and shifting the lateral 1/2 insertion inward to the medial side of patellar tendon, and reconstructing the patellar tendon insertion were used in correcting the maltracking of patellofemoral joints when the TKA was conducted for 49 knee joints of 48 cases. All the cases were females, aged 53-76 years old （66.8 on average）. The course of disease was 6-23 years （16.2 years on average）. Among all the cases, 37 with 38 knee joints were osteoarthritis, and 11 with 11 knee joints were arthritis pauperum. Different degrees of genu valgum and external rotation of knee joints were found in all cases. The genu valgum angle was 23-42° with an average of 33°. The Q angle was 16-23° with an average of 19°. Flexion deformity of knee joints with 8-35° （22° on average） was found in 23 cases. The preoperative KSS knee joint score was 21-51 points （32 points on average）, and the function score was 29-45 points （33 points on average）. Results All incisions obtained healing by first intension. All the patients were followed up for 7-82 months （52 months on average）. Genu valgum deformity of knee joints was corrected in all cases. Residual flexion deformity with 5° of knee joints was found in 3 cases. The running track of patellofemoral joints returned to normal in all cases. Laceration or fragmentation was not found in reconstructed patellar ligaments. The postoperative KSS knee joint score was 76-89 points （82 points on average）, and the function score was 81-90 points （85 points on average）. The X-ray films from the very beginning of post-operation to the end of follow-up showed the prosthesis was normal. Conclusion In correcting the maltracking of patellofemoral joints in TKA, releasing lateral retinaculum and tightening medial retinaculum of patellar, adjusting the position of the tibial prothesis properly, shifting the lateral 1/2 insertion inward to the medial side of patellar tendon and reconstructing the patellar tendon insertion were efficient methods, without any adverse effect on the early rehabilitation training of knee joins.