人工膝关节置换辅以个体化软组织平衡治疗膝关节外翻畸形32例

Total knee arthroplasty combined with individualized soft tissue balance technique for valgus knee deformity: an analysis of 32 cases

背景:与膝关节内翻畸形相比,膝关节外翻畸形的临床病例数较少,但其手术难度比膝关节内翻畸形大,手术技术要求高,其中截骨技术和软组织平衡技术最难把握,国内外尚无统一的技术规范。目的:探讨人工膝关节置换治疗重度膝关节外翻畸形的个体化软组织平衡技术及早期临床疗效。方法:选取2013年9月至2016年5月在沈阳军区总医院行初次全膝关节置换患者32例(35膝)进行回顾性分析。常规选择髌旁内侧入路,应用标准化截骨及个体化软组织平衡技术。以膝关节活动度、股胫角及HSS膝关节评分评价置换后疗效。结果与结论:(1)所有患者均得到随访,随访时间16-44个月;(2)患者膝关节活动度由置换前(62.1±15.8)°提升至末次随访时(108.7±25.9)°;股胫角由置换前(28.6±7.0)°降低至末次随访(6.7±2.2)°;HSS膝关节评分由置换前(26.8±7.6)分提升至末次随访时(86.9±18.5)分。患者置换前与末次随访时的HSS评分、股胫角、膝关节活动度比较,差异均有显著性意义(P<0.05);(3)置换后3例(3膝)存在膝关节内侧不稳症状,2例(2膝)置换后出现腓总神经麻痹症状,均已恢复;(4)结果提示,应用个体化软组织平衡技术的人工全膝关节置换治疗膝关节外翻畸形的短期疗效满意,能够明显减轻患者疼痛,恢复患肢正常力线及功能。

BACKGROUND： Although the incidence of valgus deformity is less than the varus deformity, the operation is more difficult and the technical requirements are higher. The techniques of osteotomy and soft tissue balance are most difficult to grasp, and there is no unified technical specification at home and abroad. OBJECTIVE： To analyze the individualized soft tissue balance technique and early clinical efficacy of total knee arthroplasty for severe knee valgus deformity. METHODS： A retrospective analysis was made in 32 cases （35 knees） undergoing primary total knee arthroplasty in the General Hospital of Shenyang Military Region from September 2013 to May 2016. All patients underwent standardized osteotomy and individualized soft tissue balance technique by patellar medial approach. The postoperative effects were evaluated by the range of motion of knee joint, the postoperative femorotibial angle and the Hospital for Special Surgery knee score. RESULTS AND CONCLUSION： （1） All patients were followed up for 16-44 months. （2） The range of motion of knee joint was increased from （62.1±15.8）° to （108.7±25.9）° at the last follow-up. The femorotibial angle was reduced from （28.6±7.0）° to （6.7±2.2）° at the last follow-up. The Hospital for Special Surgery knee score was increased from 26.8±7.6 to 86.9±18.5 at the last follow-up （P 〈 0.05）. （3） Three cases （three knees） had the symptoms of medial instability of the knee joint, two cases （two knees） had the symptoms of general peroneal paralysis postoperatively, and all recovered. （4） These findings imply that total knee arthroplasty with individualized soft tissue balance technique for valgus deformity can obviously relieve the pain and restore the lower limb alignment, and clinical results are satisfactory.