侧方移位失稳膝关节的人工膝关节置换

Total knee arthroplasty for the knees with severe sidewards instability

[目的]探讨膝关节侧方移位失稳患者行全膝关节置换方法和疗效。[方法]对2010年1月～2016年6月收治的17例(20膝)成人膝关节骨性关节炎或类风湿关节炎合并膝关节侧方移位失稳患者行人工膝关节置换手术治疗。男6例(8膝),女11例(12膝);年龄60～75岁,平均67.82岁。左侧10例(12膝),右侧7例(8膝)。17例(20膝)均表现为股骨远端关节面相对胫骨平台向内侧水平移位,侧方移位距离平均(12.05±2.31 mm)(0.9～15 mm),其中5例(5膝)侧位X线片上还呈现股骨远端关节面向后移位。[结果]所有患者均获随访,随访时间10～50个月,平均31.54个月。KSS临床评分从术前平均(33.31±12.50)分(9～45分)提高至末次随访时平均(88.72±6.55)分(82～95分),KSS功能评分从术前平均(36.25±9.58分)(28～46分)提高至末次随访时平均(85.80±6.38)分(79～91分)。膝关节活动度由术前平均69.45°±28.80°(41°～98°)提高至末次随访时平均103.55°±13.18°(90°～120°)。本组病例无深部感染、血栓形成、膝关节不稳、假体松动及脱位等并发症发生。[结论]侧方移位失稳的膝关节行初次人工全膝关节置换手术时应对膝关节侧副韧带结构与功能状况进行准确评估,有针对性的软组织平衡技术以及正确选择假体限制级别是手术成功的关键。

[Objective] To investigate the technique and clinical outcome of primary total knee arthroplasty （TKA） for the knee with sidewards displacemeni and instability. [Method] From January 2010 to June 2012, 17 patients （20 knees） with side- wards displacement and instability underwent primary TKA. There were 6 males （8 knees） and 11 females （12 knees）, aged for an average of 67.8 years ranged from 60 to 75 years. In term of the primary disease, osteoarthritis in 9 patients （10 knees） and rheumatoid arthritis in 8 patients （10 knees） were included into this study. The preoperative sideward displacement in the coronal plane proved （12.05±2.31） mm on average, ranged from 0.9 to 15 mm on the AP views. [Result] All the patients were followed up for an average of 31.50 months, ranged from 10 to 50 months. The KSS clinical score significantly improved from （33.31± 12.50） （ range, 9-45） preoperatively to （88.72±6.55） （range, 82-95） at the latest follow up （P〈0.05）. Likewise, the KSS functional score considerably improved from （36.25±9.58） （range, 28-46） preoperatively to （85.80±6.38） （range, 79-91） at the final follow-up （P〈0.05）. In addition, the range of motion of the affected knee increased from （69.45±28.80）° （range, 41°-98°） preoperatively to （103.55± 13.18）° （range, 90°- 120°） at the latest follow up （P〈0.05）. No complications, such as infection, deep vein thrombosis, knee instability and component loosing, occurred in anyone of them. [Conclusion] TKA for the knees with sidewards displacement and instability demands precise evaluation for the structure and function of the ligaments of knee. The good balance of soft tissues and correct selection of the constraint level of TKA prosthesis are the key points for successful operation.