伸直间隙优先截骨法在膝关节置换中的应用及临床效果

Extension First Osteotomy in Total Knee Athroplasty

目的探讨应用伸直间隙优先截骨法在全膝关节置换过程中应用及临床效果。方法对39例患者39膝（骨关节炎36例,类风湿关节炎3例）行人工膝关节表面置换术,应用LDK JOINT PS型假体。术中按术前测量外翻角度先进行股骨远端截骨,再根据胫骨髓外定位装置,行胫骨平台截骨,最后行股骨前后、斜面及髁间窝的截骨,髌骨不常规置换。记录手术时间,置换后引流量,置换前及置换后2,6周膝关节活动度,并进行统计学分析结果 39例患者均获得随访,随访时间4～30个月,平均14个月。手术时间平均（118.3±30.4）min,置换后引流量平均（272.7±106.1）mL。置换后6、12周患者膝关节活动度及美国特种外科医院（the hospital for special surgery,HSS）评分均较置换前明显改善（P〈0.05）。术后患者均未出现感染,未出现假体排异反应。结论伸直间隙优先截骨法在全膝关节置换过程中,减少重复截骨的发生率,显露清晰,操作简便,可以充分保证术后膝关节完全伸直,力线正确。

Objective To explore the clinical effect of the extension first osteotomy in the process of total knee athroplasty.Methods A retrospective study was performed for 39 cases.There were 36 cases of osteoarthritis,3 cases of rheumatoid arhritis.The LDK JOINT prosthesis were used for total knee arthroplasty.The distal femoral osteotomy was performed firstly according to the valgus angle measured preoperatively,and then the tibial plateau osteotmy was performed based on the tibial extramedullary positioning device.Patella was not routine replacement.Last we performed oblique osteotomy anterior and posterior to the distal femur（ contained intercondylar osteotomy）.The operation time,postoperative drainage volume,range of motion of knee joint as well as Hospital for Special Surgery knee scores before replacement and 2 and 6 weeks after replacement were recorded and statistically analyzed.Results All the 39 patients were followed up for 3 to 14 months.The average operation time was（ 118.3 ± 30.4） minutes; the postoperative drainage volume was（ 272.7 ± 106.1） mL.The range of motion of knee joint and Hospital for Special Surgery knee scores 2 and 6 weeks after replacement were improved compared with those before replacement（ P〈0.05）.There was no infection,no prosthesis rejection.Conclusion That the improved osteotomy can make the bone cutting more accurate,and reduce the chance and risk of osteotomy repeatedly.This method has the advantages of simple operation,shortening the operation time,reducing the intraoperative blood loss,protecting the surrounding soft tissue safely,ensuring the postoperative totally extend knee and better limb alignment.