严重膝外翻全膝关节置换治疗的疗效观察

Clinical Effect of Total Knee Arthroplasty For Severe Senu Salsum Deformity Clinical Evaluation

目的 探讨全膝关节置换术治疗严重膝外翻畸形的手术方法和临床疗效.方法 2010年3月至2011年12月,对18 例（25膝）严重膝外翻患者进行全膝关节置换.术前X线测量股胫角（femorotibial angle,FTA）,检查膝关节活动度,进行HSS评分.手术采用髌旁内侧入路、常规截骨、选择性的外侧软组织松解、安装后稳定型假体或半限制型假体进行全膝关节置换术.术后测量FTA角,术后定期随访检查膝关节活动度并行HSS评分.结果 所有患者均获得随访,随访时间3～24个月.FTA角由术前的25.5°（18°～39°）降低至4.7°（1°～8°）;膝关节活动度由术前的72.1°（67°～95°）提高到107.3°（100°～120°）;HSS评分由术前的24.5分（16～38分）提高到89.3分（84～96分）,差异均有统计学意义（P＜0.01）.结论 对于严重膝外翻畸形的患者,采用髌旁内侧入路、常规截骨、选择性的外侧软组织松解、安装后稳定型的假体或半限制型假体实施人工全膝关节置换术治疗,能够取得满意的临床效果,可以明显改善患者膝关节的功能,提高患者的生活质量.

Objective To evaluate the clinical efficacy and surgical methods of the total knee arthroplasty （TKA） for se- vere senu valsum deformity Methods Eighteen patients （25 knees） were enrolled from March 2010 to December 2012. FTA angles, the ROM of the knee joint, HSS scores before and after the TKA operation,were meatured in order to compare the effect of surgery. Results All patients were followed up from 3 to 24 months FTA angles reduced from preoperative 25.5°（18°～39°） to 4.7° （ 1 °- 8°）. The ROM increased from preoperative 72.1 ° （67° - 95°） to 107.3° （ 100°- 120°） HSS score im- proved from 24.5 points （16 -38 ） to 89.3 points （84 -96）. Differences are all statistical significent （P 〈 0.01 ） Conclusion For severe senu valsum deformity, patellar medial approach, normal osteotomy, selective lateral soft tissue release, the instal- lation of posterior stabilized or semi-restrictive implementation of TKA can provide satisfactory clinical results, and significantly improve knee function, and quality of life.