人工全膝关节置换术中应用缩小胫骨平台截骨技术矫正膝内翻畸形的疗效观察

CORRECTION OF VARUS KNEE WITH REDUCTION OSTEOTOMY DURING TOTAL KNEE ARTHROPLASTY

目的 探讨人工全膝关节置换术中应用缩小胫骨平台截骨技术矫正膝内翻畸形的疗效。方法 回顾性分析2010年5月-2012年7月,16例（24膝）人工全膝关节置换术中采用缩小胫骨平台截骨技术矫正膝内翻畸形患者临床资料。男2例（3膝）,女14例（21膝）;年龄57~79岁,平均67岁。病程3~15年,平均9.1年。术前膝关节学会评分系统（KSS）临床评分为（38.71±10.04）分、功能评分为（50.31±14.31）分,膝关节活动度为（91.88±13.01）°,股胫角为内翻（9.04±4.53）°。术中经缩小胫骨平台截骨后内翻畸形完全矫正。结果 手术时间85~245 min,平均165.5 min。显性失血量10~800 m L,平均183.1 m L。住院时间8~22 d,平均13.6 d。术后切口均Ⅰ期愈合,无相关并发症发生。患者均获随访,随访时间37~62个月,平均48个月。术后48 h拔除引流管后复查X线片示,膝关节股胫角为外翻（3.92±1.89）°,下肢力线均恢复正常;随访期间无假体松动、下沉。末次随访时,膝关节KSS临床评分为（84.21±6.49）分、功能评分为（85.31±6.95）分,膝关节活动度为（105.83±11.29）°,与术前比较差异均有统计学意义（t=20.665,P=0.000;t=9.585,P=0.000;t=8.333,P=0.000）。结论 对于膝关节骨关节炎伴内翻畸形患者,人工全膝关节置换术中应用缩小胫骨平台截骨技术可有效矫正内翻畸形,术后下肢力线恢复良好,膝关节活动度及功能恢复满意。

Objective To evaluate the effectiveness of reduction osteotomy for correction of varus knee during total knee arthroplasty. Methods A retrospective analysis was made on the clinical data of 16 patients （24 knees） who received reduction osteotomy for correcting varus knee during total knee arthroplasty between May 2010 and July 2012. There were 2 males （3 knees） and 14 females （21 knees）, with an average age of 67 years （range, 57-79 years）. The disease duration ranged from 3 to 15 years （mean, 9.1 years）. The Knee Society Score （KSS） was 38.71±10.04 for clinical score and 50.31±14.31 for functional score. The range of motion （ROM） of the knee was （91.88±13.01）°. The tibiofemoral angle was （9.04±4.53）° of varus deformity. Reduction osteotomy was applied to correct varus knee. Results The operation time was 85-245 minutes （mean, 165.5 minutes）; the obvious blood loss was 10-800 mL （mean, 183.1 mL）; the hospitalization time was 8-22 days （mean, 13.6 days）. All incisions healed by first intention. No neurovascular injury or patellar fracture occurred. The follow-up duration ranged from 37 to 62 months （mean, 48 months）. The tibiofemoral angle was corrected to （3.92±1.89）° of valgus at 48 hours after operation. The lower limb alignment recovered to normal. The X-ray films showed no evidence of obvious radiolucent line, osteolysis, or prosthesis subsidence. The results of KSS were significantly improved to 84.21±6.49 for clinical score and 85.31±6.95 for functional score （t=20.665, P=0.000; t=9.585, P=0.000）; and ROM of the knee was significantly increased to （105.83±11.29）° （t=8.333, P=0.000） at last follow-up. Conclusion The effectiveness of reduction osteotomy for varus knee deformity during total knee arthroplasty is satisfactory. Proper alignment, ROM, and function of knee can be achieved.