全膝关节置换治疗成人膝外翻畸形:胫股角及膝关节活动度变化

Total knee arthroplasty for knee valgus deformity in the adults:Changes of tibiofemoral angle and range of motion of knee joint

背景:膝外翻畸形施行人工全膝关节置换难度很大,涉及面多,争议亦颇多。目的:观察全膝关节置换治疗成人膝外翻畸形的手术方法和临床效果。方法:对12例15膝采用髌骨内侧入路,正确截骨,选择性的软组织松解,恢复膝关节正常的力线和软组织平衡,采用后稳定型假体进行全膝关节置换,获得膝关节的稳定,置换后采取针对性的康复训练,置换前后测量胫股角,并置换后定期随访检查膝关节活动度并进行HSS评分。结果与结论:所有患者获得随访均>6个月。置换前胫股角平均21.47°降低至置换后的5.47°(P<0.01),膝关节活动度由置换前的81.33°提高到121.07°(P<0.01);HSS评分由置换前的25.47分提高到89.87分(P<0.01)。置换后1例出现关节积液较多,2例出现膝关节内测不稳。无髌骨脱位或半脱位,下肢力线均恢复正常。提示成人膝外翻畸形经全膝关节置换后外翻畸形均得到纠正,功能较前明显改善。

BACKGROUND： Application of total knee arthroplasty （TKA） for knee valgus deformity can be difficult technically in many aspects and exist a lot of controversy. OBJECTIVE： To investigate the clinical efficiency and surgical methods of TKA for knee valgus deformity in the adults. METHODS： Totally 15 knees from 12 patients underwent patellar lateral approach for proper osteotomy and selective lysis of the soft tissue to regain normal biomechanics and soft tissue balance of knee were selected. Posterior stabilized prosthesis was used for TKA to obtain the stability of the knee. After the surgery, rehabilitation therapy pertinently was adopted. Before and after the surgery, tibiofemoral angle was measured. Range of motion （ROM） was examined and HSS score was evaluated. RESULTS AND CONCLUSION： All patients were followed up over 6 months. Tibiofemoral angle decreased from 21.47% preoperatively to 5.47% postoperatively （P 〈 0.01 ）. The ROM increased from 81.33% preoperatively to 121.07% postoperatively （P 〈 0.01 ）. HSS score improved from 25.47 preoperatively to 89.87 postoperatively （P 〈 0.01 ）. After replacement, 1 case affected more joint effusion, 2 cases affected knee instability. There was no dislocation or subluxation of the patella. Force line of lower limb returned to normal. TKA can effectively correct the knee valgus deformity, and can significantly improve the function of the knee.