“inside-out”技术在合并膝外翻畸形的全膝关节置换术中的应用

Application of the “inside-out” technique in total knee arthroplasty for severe valgus deformity

目的探讨全膝关节置换术中应用"inside-out"技术治疗严重膝关节外翻畸形的临床疗效。方法选取2013年2月至2015年2月我院收治的11例(13膝)严重膝外翻的患者,于全膝关节置换术中采用"inside-out"技术进行外侧软组织松解,于手术前后测量股胫角,检查膝关节活动度并采用美国特种外科医院(American Hospital for Special Surgery,HSS)膝关节评分标准评价关节功能,记录手术并发症。结果所有患者均未使用限制型假体,且均获得随访,平均随访时间为(10.0±2.2)个月;术后随访未发生切口血肿、韧带松弛及关节不稳,影像学及临床症状分析未发现假体松动。股胫角由术前的15.2°±3.1°改善为6.3°±1.8°,膝关节活动度由术前的90°±14°改善为102°±11°,HSS评分由术前的(39.2±9.6)分改善为(78.3±9.2)分,以上指标手术前后比较,差异均有统计学意义(均P<0.05)。结论全膝关节置换术中应用"inside-out"技术治疗严重膝外翻畸形,简单有效、安全、可重复性强,应用非限制型膝关节假体,减少了血肿、关节不稳、假体松动等并发症的发生,患者关节功能得到明显改善。

Objective To explore the efficacy and safety of the ＂inside-out＂ technique in total knee arthroplasty （TKA） for severe valgus deformity. Methods Eleven patients （thirteen knees） with severe valgus deformity underwent TKA using the ＂inside-out＂ technique between February 2013 and February 2015. Femo- ral tibial angle （FTA）, range of motion （ROM）, American Hospital for Special Surgery （HSS） scores and surgical complication were used to evaluate the results. Results The mean duration of follow-up was （10.0 ±2.2） months. There were no cases of hematoma formation, excessive release of the medial collateral ligament, or acute or delayed instability, no constrained implants. There was no evidence of implant loosening on radio- graphs and clinical symptoms. The mean preoperative FTA was 15.2°±3.1° of valgus, which was corrected to 6.3°± 1.8° after surgery. The mean ROM was improved from 90°± 14° preoperatively to 102°± 11 ° at the final follow-up. The mean HSS score was improved from 39.2±9.6 to 78.3±9.2. These differences were statistically significant （P 〈 0.05 for all）. Conclusion The ＂inside-out＂ technique was safe, reproducible, and effective in treating valgus deformity of the knee during TKA. It reduced the risks of surgical complication and improved the knee function.