五合一股骨截骨技术在全膝关节置换术中的应用

Five-in-one osteotomy technique of the distal femur in total knee arthroplasty

目的探讨应用五合一股骨截骨技术和Deluxe-ps型假体行人工膝关节置换术的近期疗效。方法 2008年10月至2009年12月,应用股骨五合一截骨法采用Deluxe-ps型膝关节假体行TKA手术20例,25膝。对照组为同期应用传统股骨四合一截骨技术,采用Depuy P.F.C.Sigma型膝关节假体行TKA手术17例,22膝。术中测量五合一截骨后各平面夹角和股骨远端前后径距离,计算各角度、距离与对应假体设计参数的差值。术后X线片测量两组外翻角、股骨假体屈曲角以评估股骨侧假体位置。采用KSS评分和功能评分、膝关节ROM评估两组手术前、后膝关节功能。结果两组所有患者均获得随访6～20个月,平均12个月。本组五合一截骨后各平面夹角、股骨远端前后径距离与对应假体设计参数的差值,差异无统计学意义,两组术前、术后随访KSS评分和功能评分、膝关节ROM差异有统计学意义,两组术后随访KSS评分和功能评分、膝关节ROM差异无统计学意义。两组术后X线片评定假体位置、力线、固定性能等均显示良好,其中外翻角、股骨假体屈曲角与对照组比较差异无统计学意义。结论初次TKA手术采用五合一股骨截骨技术和Deluxe-ps型假体术后近期疗效满意。

Objective To explore the short-term efficacy of five-in-one osteotomy technique of the distal femur and Deluxe-ps-type prosthesis in total knee arthroplasty. Methods From October 2008 to December 2009, five-in-one femoral osteotomy technique which used Deluxe-ps-type TKA knee prosthesis in surgery was applied to 20 cases with 25 knees, while in the control group, four-in-one traditional osteotomy technique which used Depuy PFCSigma type TKA knee prosthesis in surgery was applied to 17 cases with 22 knees. During the operation, after the five-in-one osteotomy, the angles between each plane and the anteroposterior diameter of the distal femur were measured; the differentials of the design parameters of prosthesis corresponding to the angles and distance were calculated. The postoperative X-ray was used to measure valgus angle and flexion angle of femoral prosthesis in two groups, so that the position of femoral lateral prosthesis could be evaluated. KSS score, function score, and knee rany of motion （ROM） were used to assess knee joint function before and after operation. X-ray was used to assess the position of implant. Results All patients of two groups were followed up for six to 20 months, with an average time of 12 months. After five-in-one osteotomy of the distal femur, the discrepancies of the osteotomy plane angle, and anteroposterior diameter of the distal femur compared with the design parameters of prosthesis, had no statistical significance. Before and after follow-up, KSS score, function score, and knee ROM had statistical significance, but in postoperative follow-up, KSS score, function score, and knee ROM of the two groups had no statistical significance. Furthermore, according to the postoperative X-ray assessment, prosthesis position, force line and fixed properties of the two groups all resulted well. Comparing the valgus angle and flexion angle of femoral between the two groups, there was no significant difference. Conclusions The results of the primary TKA surgery that used five-in-one femoral osteotomy technique and Deluxe-ps prosthesis were satisfied in early follow-up.