Ⅱ度膝外翻患者稳定型假体置换43例报告

Clinical effects of posterior-stabilizing prosthesis in total knee arthroplasty for type Ⅱ valgus deformity:a report of 43 cases

目的探讨II度膝外翻畸形全膝关节置换术中使用后稳定型假体治疗的临床疗效。方法回顾2011年3月至2013年3月,共43例(49膝)II膝外翻畸形的患者,均接受全膝关节置换手术。手术采用髌旁内侧入路、常规截骨、外侧软组织松解,所有患者均采用后稳定型假体植入。于术前和术后1、3、6、12、24个月摄膝关节正位X线片、测量股胫角(FTA)改变,测定膝关节活动度(ROM)和进行HSS评分,评估术后临床疗效。结果 43例(49膝)均获得随访,随访时间14~46个月,平均28.4个月。X线片显示假体位置良好,未见明显松动和下沉迹象。FTA由16.9°(14°~20°)恢复至5.4°(3°~8°),术前关节活动度平均90.3°(80°~95°),末次随访时平均115.5°(105°~125°)。术前HSS评分平均41.2(36~43)分,末次随访时平均88.6(84~95)分。所有患者术后均未出现严重并发症。差异均有统计学意义(P<0.05)。结论选择后稳定型假体治疗II度膝外翻畸形,通过截骨、良好的软组织平衡及调节聚乙烯垫片的厚度,可取得满意的临床疗效,能够纠正膝关节外翻畸形,显著地改善患者膝关节的功能。

Objective To investigate the clinical effects of posterior-stabilizing prosthesis in total knee arthroplasty （ TKA ） for type Ⅱ knee valgus deformity. Methods A total of 43 patients （ 49 knees ） with type Ⅱ valgus deformity were performed TKA （ medial patellar approach, routine osteotomy, lateral soft tissue release ） by using posterior-stabilizing prosthesis from March 2011 to March 2013. Radiography images, FTA angles, ROM and HSS were recorded preoperatively, 1, 3, 6, 12, 24 months postoperatively to evaluate the effects of surgery and prosthesis. Results All 43 patients （ 49 knees ） were followed up with a mean period of 28.4 months （ range： 14 - 46 months ）. The radiography evaluation indicated that there was no prosthesis loosening or sinking. FTA angles reduced from 16.9° （ range： 14° - 20° ） preoperatively to 5.4° （ range： 3° - 8°） postoperatively. The range of motion was corrected from the mean 90.3° （ range： 80° - 95° ） preoperatively to the mean 115.5° （ range： 105° - 125° ） at the latest follow-up. The HSS knee score improved from 41.2 （ range： 36 - 43 ） preoperatively to 88.6 （ range： 84 - 95 ） at the latest follow-up. No severe complications occurred. Differences were all statistically significant （ P 〈 0.05 ）. Conclusions For type II knee valgus deformity, TKA by medial patellar approach, routine osteotomy, lateral soft tissue release, posterior-stabilizing prosthesis can get satisfactory clinical effects, correct FTA angles, and significantly improve knee functions and the quality of life.