后稳定型全膝关节置换治疗成人膝大骨节病混合内翻畸形

Stabilized Prosthesis after Total Knee Arthroplasty for the Adult Kaschin-Beck Disease with Genu Valgum Mixed Deformities

目的探讨后稳定型全膝关节置换治疗成人膝大骨节病混合内翻畸形的手术方法及临床疗效。方法应用后稳定型全膝关节置换治疗晚期成人膝大骨节病混合内翻畸形29例(31膝),男16例(17膝),女13例(14膝)。年龄56～79岁,平均65.2岁。病程3.9～29年。术前屈曲挛缩畸形5°～40°,平均12.4°,膝内翻畸形5°～20°,平均11.5°,术前内旋转度7°～14°。用膝关节HSS评分标准及畸形矫正角度进行效果评价,术前平均40.98分。结果本组有1例下肢血栓性静脉炎经保守治疗痊愈,1例术后心肌梗死经抢救治愈,对全部病例进行了平均28个月(2个月～6年)的随访,术后6个月髌前痛1例,行股四头肌功能锻炼疼痛消失,随访期间无假体周围透明带出现,无假体下沉或松动,无植骨块移位、骨折、骨吸收、不愈合及胫骨平台塌陷。终末随访HSS评分为86.34分。优21膝(67.7%),良9(29%),尚可1膝(3.23%)。结论应用后稳定型全膝关节置换治疗成人膝大骨节病,可有效矫正内翻、屈曲、内旋混合畸形,缓解疼痛,重建膝关节功能,近期疗效满意。

Objective To explore the operative treatment and clinical effect of stabilized prosthesis in total knee arthroplasty for the adult Kaschin-Beck disease with genu valgum mixed deformities.Methods From January 2002 to March 2010,23 cases of adult Kaschin-Beck disease with genu valgum（27 knees） accepted total knee arthroplasty with stabilized prosthesis,including 16 males（17 knees） and 13 females（14 knees） with an average age of 65.2 years（range,56-79 years）.The average flexion was 12.4°（5°-40°） preoperatively,the average knee genu valgum was 11.5°（5°-20°） preoperatively.The Hospital for Special Surgery（HSS） knee-rating score（average 41.3° preoperatively） and correct angle were used for the functional assessment of the treatment.Results Thrombophlebitis of lower extremity in 1 cases was cured by non-surgical treatment.The patients were followed up for 2 months to 6 years（28 months on average）.1 case complicated by patellar pain in the 6 th month after surgery was cured by the exercise of the femoral quadriceps.No complication happened.The Hss scorew as 81.3 at the last follow-up.The clinical effect was excellent in 21 knees（67.7%）,good in 9 knees（29%） and fair in 1 knees（3.23%）.Conclusion After operative treatment of total knee arthroplasty with stabilizedprothesis for the adult Kaschin-Beck disease with genu valgum mixed deformities,the deformity were corrected in all patients,the pain was alleviated.it is useful for functional reconstruction of knees.The treatment outcomes were satisfactory within 2-72 months after surgery.