全膝关节置换术治疗膝外翻畸形的手术探讨

Disscussion on total knee arthroplasty with valgus deformity

[目的]探讨人工膝关节置换治疗膝外翻畸形的手术方法及临床疗效。[方法]自2008年1月-2012年1月本院收治的42例膝外翻畸形行人工膝关节置换的患者中,采用髌旁内侧入路31例,髌旁外侧入路11例;采用非限制性假体32例,限制性假体10例。比较患膝术前、术后的ROM、FTA角以及膝关节KSS评分及功能评分,评价手术效果。[结果]所有病例均得到随访,随访时间12-24个月（平均16个月）,术前FTA角平均24.2°（11°-35°）,术后平均6.4°（5°-12°）。KSS评分由术前平均27.4分（12-42分）提高到平均89.3分,功能评分由术前21.0分（14~35分）提高至87.5分（78-92分）。FTA角、KSS评分及膝关节功能评分与术前比较均有统计学意义（P〈0.05）。术后均未发现髌骨脱位、髌前痛、腓总神经损伤、深静脉栓塞等并发症。[结论]人工膝关节置换术治疗膝外翻畸形具有良好的临床效果,术中正确的截骨,配合充分的软组织松解,可有效恢复患者下肢力线。

[Objective] To investigate the methods and clinical efficacy of total knee arthroplasty（ TKA） in patients with knee valgus deformity. [Methods] Between January 2008 and January 2012,42 patients with knee valgus deformity were treated by TKA. Thirty-one patients were performed by medial parapatellar approach,other 11 patients used lateral approach. The unrestricted prosthesis was in 32 knees and the constrained prosthesis was in 10 knees. The range of motion（ ROM） of the knee,femoro-tibial angle,Knee Society system（ KSS） and function scores were compared. Efficacy of the surgery was evaluated.[Results] All patients were followed up for 12 to 24 months. FTA angles reduced form preoperative 24.2°（ 11° -35°） to6. 4°（ 5° - 12°）. KSS score improved from 27. 4points（ 12 - 42 points） to 89. 3 points（ 80. 3 - 92. 4 points）. Functional score improved from 21 points（ 14 - 35 points） to 87. 5 points（ 78 - 92 points）. It had statistical improvement（ P〈0. 05）compared with pre-operation. No patellar dislocation,anterior knee pain,damage of common peroneal nerve and DVT was found postoperatively. [Conclusion] TKA can provide excellent results for knee valgus deformity. Through techniques of osteotomy and soft tissue releasing correctly,the line of force of the lower limbs can be recovered.