全膝关节置换治疗膝屈曲内翻畸形的软组织平衡

Soft tissue balance in total knee arthroplasty for patients with knee of flexion contracture and varus deformity

目的探讨全膝关节置换治疗膝关节屈曲内翻畸形的软组织平衡技术及效果。方法回顾性分析2006年6月～2010年6月20例22膝骨性关节炎和3例4膝类风湿性关节炎合并屈曲内翻畸形行全膝关节置换手术病例的资料,对术前畸形、术中的软组织平衡和术后功能恢复问题进行讨论。男7例8膝,女16例18膝;年龄55￣83岁,平均67.8岁。术前膝关节屈曲挛缩畸形7°￣50°,平均(13.6±2.2)°;以正常股胫角外翻6°为标准,术前膝内翻角度为8°￣23°,平均(12.5±1.9)°。术前膝关节HSS(hospitalofspecialsurgery,HSS)评分为30￣66分,平均(39.0±2.8)分。结果术中23膝关节完全伸直,3膝残留5°屈曲挛缩;术中并发内侧副韧带损伤2例,髌韧带部分撕裂1例。术后23膝股胫角外翻角度3.5°～7.4°,3例残留股胫角内翻角2°￣5°,术后平均膝内翻角度(1.7±0.8)°,与术前比较差异有统计学意义(P<0.05)。术后并发下肢深静脉血栓2例,1例切口脂肪液化,均无切口感染及深部感染发生。术后随访6￣29个月,平均18个月,23膝关节完全伸直,3膝残留5°￣10°屈曲挛缩,术后平均膝屈曲(0.9±0.4)°,与术前比较差异有统计学意义(P<0.05)。术后末次随访膝关节HSS评分为73￣92分,平均(85.0±2.6)分,与术前比较差异有统计学意义(P<0.05)。结论软组织平衡是全膝关节置换治疗膝关节屈曲内翻畸形的重要步骤和手段,合理良好的软组织平衡技术是膝关节功能得以恢复和畸形得以矫正的重要保障。

[Objective] To explore techniques of the soft tissue balance in the total knee arthroplasty （TKA） for patients with knee of flexion contracture and varus deformity. [Methods] 7 men and 16 women aged 55 to 83 （mean, 67.8） years who had flexion contracture and varus deformity underwent TKA using the techniques of the soft tissue balance. All these cases included 22 knees of osteoarthritis in 20 patients and 4 knees of rheumatoid arthritis in 3 patients. The flexion eontracture angle was averaged （13.6±2.2）° （range, 7°- 50°）. Taking tibiofemoral valgus angle being 6° as the standard, and the varus deformity angle was averaged （12.5±1.9）° （range, 8°-23°）. [Results] There were 23 flexion contractures con＇ected completely during operation, 3 flexion contracture angles remained 5°. The complications occurring during operation included 2 medial collateral ligaments, and 1 patellar ligament injuries. After operation 23 knees had tibiofemoral valgus angle ranged 3.50-7.4°, and 3 knees had residual tibiofemoral varus angle ranged 20-5°, and mean knee varus angle was （1.7±0.8）°. After operation 2 deep vein embolisms were intercurrent,and 1 cut fat deliquesce, and nocut infected. All patients were followed up for 6 to 29 （mean, 18） months, and 23 flexion contractures corrected completely, but 3 flexion eontracture angles remained 5°-10°, and mean knee flexion contractures angle was （0.9±0.4）°. The HSS score increased from 39.0±2.8（range, 30-66） preoperatively to 85.0±2.6 （range, 73- 92） postoperatively at last. [ Conclusion ] The soft tissue balance is a major management for correction of the varus deformity and the flexion contracture. The proper balancing of the soft tissues can achieve an obvious recovery of the function and correction of the deformity after total knee arthroplasty.