髁限制性膝关节假体治疗严重膝内翻畸形合并胫骨平台内侧骨缺损

The Therapeutic Effects of LCCK in Treatment of Serious Malformation of Genu Varum Associated with Medial Tibial Plateau Bone Defects

目的探讨髁限制性膝关节假体在膝骨关节炎严重内翻畸形合并胫骨平台内侧骨缺损行全膝关节置换术中的应用及疗效观察。方法回顾分析2008年1月至2011年1月12例骨性关节炎严重膝内翻畸形合并胫骨平台内侧骨缺损行髁限制性膝关节假体全膝关节置换术患者资料,术前负重位膝内翻畸形平均34°,胫骨平台内侧骨缺损为非包容性,依据AORI分型为Ⅱ、Ⅲ型,采用美国膝关节学会评分(knee society score,KSS)系统评估膝关节功能,包括膝评分和膝功能评分。结果本组均获随访,随访6～18个月,平均13个月,KSS膝评分和膝功能评分从术前(19.5±4.2)分、(16.2±5.4)分提高到术后(87.7±5.6)分、(85.4±8.3)分,分析术前及术后KSS膝评分及膝功能评分的差异有统计学意义。结论髁限制性膝关节假体全膝关节置换是治疗膝骨关节炎严重内翻畸形合并胫骨平台内侧骨缺损的有效方法,术中采取适度的软组织松解及正确的截骨,针对胫骨平台内侧骨缺损选用组合式金属垫块及假体延长柄,适度增加关节的限制性,可以转移力学负荷,增加假体的稳定性,最终获得良好效果。

Objective To investigate the application and therapeutic effects of LCCK in treating serious malformation of genu varum associated with medial tibial plateau bone defects.Methods from JAN 2008 to JAN 2011,12 cases of OA with serious malformation of genu varum associated with medial tibial plateau bone defects,were retrospective analyzed.All the patients received LCCK TKA.The average angle of preoperative weight-bearing knee varus deformity was 34°,the medial bone defect of tibial plateau was non-inclusion,and the type Ⅱ and Ⅲ according to AORI.The Knee Society Score（KSS） was employed to evaluate the knee function,including knee score and knee function score.Results All the patients were followed-up for 6 to 18 months（average 13 months）.The preoperative and postoperative KSS knee score and knee function scorewere（19.5±4.2）、（16.2±5.4） and（87.7±5.6）、（85.4±8.3） respectively.There was significant statistic differences between preoperative and postoperative scores.Conclusion Total knee replacement by using LCCK is one effective method to cure serious malformation of genu varum associated with medial tibial plateau bone defects.Taking moderate soft tissue release and correct osteotomy,choosing modular metal pad and extended prosthesis components according to the medial plateau bone defects,moderately increasing joint constraint can transfer mechanic load,arise the stability of prosthesis and get good therapeutic effect.