股骨-胫骨通配型全膝关节假体治疗重度内翻膝

Femur Tibial All-matched Prosthesis Total Knee System in the Treatment of the Severe Varus Knee

目的:探讨应用股骨-胫骨通配型全膝关节假体治疗合并胫骨平台骨缺损的重度内翻全膝的近期疗效。方法:对我院2012年1月至2013年5月40例(43膝)重度骨关节炎应用股骨-胫骨通配型全膝关节行全膝关节置换术,其中6例为合并内侧胫骨平台骨质缺损重度内翻畸形。术前检查膝关节活动度,用X线测量股胫角(femorotibial angle,FTA)测量KSS评分。手术采用髌旁内侧入路、常规截骨,胫骨平台骨质缺损病例采用适当增加胫骨平台截骨量、骨水泥填充及自体骨植骨并配合使用胫骨侧延长杆以增加膝关节假体的稳定性,所选假体为北京爱康宜诚公司生产的股骨-胫骨通配型全膝关节假体。术后测量FTA角,随访6个月至1年,定期测量膝关节活动度并采用KSS评分评定治疗效果。结果:患者手术均顺利完成。36例获得随访,其中包括合并胫骨平台骨质缺损5例。术后无切口感染、关节脱位等并发症。术后6个月按KSS评分法评定:优30例,良5例,中1例,优良率97℅,6例合并胫骨平台骨缺损病例均为优良。结论:应用股骨-胫骨通配型全膝关节假体治疗重度内翻膝疗效满意,尤其在治疗合并胫骨平台骨缺损病例时能有效解决股骨胫骨假体大小不匹配的问题,减少关节假体磨损率。

Objective： To study the femur tibial prosthesis all-match total knee prosthesis treatment with varus knee deformity combined with tibial plateau bone defect. Methods： From January 2012 and May 2012, 43 knees of 40 severe osteoarthritis patients underwent TKA with domestic AK femur tibial prosthesis all-match total knee prosthesis in our hospital that include 6 cases severe varus deformity combined with tibial plateau bone defect.For preoperative examination include measure the knee joint mobility and tibial femoral angle by using X ray （femorotibial angle, FTA）, measuring KSS score.Took the medial parapatellar approach in surgery, conventional bone cutting, treatment for the tibial plateau bone defect cases with increasing cutting in tibia plateau, bone cement filling and autologous bone graft and tibia lateral extension rod in order to increase the stability of the knee joint prosthesis, the femur tibial prosthesis all-match total knee prosthesis took from Beijing AKEC Co., Ltd. For postoperative follow-up over 6 months to 1 year. regular measure the KSS score, knee joint mobility and the FTA, to evaluate the treatment effect. Results： The patients were successfully completed.36 cases received follow-up, included 6 cases of combined with the tibial plateau bone defect.No complications such as postoperative incision infection and joint dislocation.According to the KSS score method to evaluate after 6 months： 30 cases excellent, 5 cases good, and 1 case medium, good rate was 97%, 5 cases severe varus deformity combined with tibial plateau bone defect was good. Conclusion： Use the femur tibial prosthesis all-match total knee prosthesis to treatment for severe varus deformity, especially for the combined with tibial plateau bone defect cases, it could solve the problems of the femurs tibial prosthesis size does not match in TKA, and reduce prosthesis wear rate.