重度膝关节外翻畸形全膝关节置换术的临床效果观察

Clinical effect of total knee arthroplasty for severe knee valgus deformity

目的探讨全膝关节置换术治疗重度膝关节外翻畸形的手术方式及临床效果。方法选择2011年3月至2013年9月我院收治的重度膝关节外翻畸形患者17例(23膝)作为研究对象,术前测量所有病例的股胫角,检查其膝关节活动度,应用HSS膝关节评分系统进行评分。通过选择髌旁外侧入路、针对性地截骨、有选择性地松解外侧软组织,对重度膝关节外翻畸形采用全膝关节置换术治疗。术后再次测量股胫角,并于术后6个月对所有病例进行复查,检查患者的膝关节活动度,同时采用HSS膝关节评分对其治疗效果进行评价。结果所有患者均于术后6个月来我院进行复查,股胫角由术前的(28.4±4.9)°下降至(5.2±2.3)°;膝关节活动范围由(65.4±16.7)°提高至(106.7±27.3)°;HSS评分由术前的(38.46±3.75)分提高到(87.41±4.77)分,术后各项指标较术前均有明显好转,差异具有统计学意义(P<0.05)。结论对重度膝关节外翻畸形患者采用髌旁内侧入路、常规截骨加选择性软组织松解后行全膝关节置换术,疗效显著,患者膝关节外翻畸形情况均得到纠正,生活质量得到显著改善。

Objective To research the clinical effect and operation way of total knee arthroplasty for severe knee valgus deformity. Methods From March 2011 to September 2013, 17 cases （23 knees） with severe knee valgus deformity were selected as the research ob- ject. Metered the tibial angle and checked the activity of knee joint of all the patients before operation. All patients were scored with HSS knee scoring system. Through the selection of lateral parapatellar approach, targeted osteotomy, selective lateral soft tissuelax, patients were given total knee arthroplasty for the treatment of severe knee valgus deformity. The femoral and tibial angle of patients was measured again after the operation. All patients were reexamined after 6 months which included checking the activity of knee joint, evaluating the therapeutic effect of patients with HSS knee scoring system. Results All patients were reexamined in our hospital 6 months after surgery, the degree of femoral and tibial angle decreased from （ 28.4±4.9 ）° to （ 5.2±2.3 ）° ; knee joint range of motion increased from （ 65.4 ±16.7 ）° to （ 106.7±27.3 ）° ; HSS score increased from （38.46±3.75 ） point to （ 87.41±4.77 ） point. Postoperative indexes were significantly improved compared with preoperative indexes, and the differences were of statistical significance （P 〈 0.05）. Conclusion The curative effect is remarkable for patients with severe knee valgus detormity using patellar medial approach, standard osteotomy combined with selective soft tissue release, and total knee arthroplasty. And the knee valgus deformity of patients was corrected and the quality of life has been significantly improved.