DFMA作为股骨远端外翻截骨角在TKA手术中的应用效果及对患者膝关节功能的影响

Effect of DFMA as a Distal Femoral Valgus Osteotomy Angle in TKA Surgery on Knee Joint Function of Patients

目的探讨股骨远端1/3解剖轴与股骨力线轴夹角(DFMA)作为股骨远端外翻截骨角测定法在膝关节置换(TKA)手术中的应用价值。方法选取我院2015年1月-2016年12月手术治疗的134例(134膝)作为研究对象,其中70例患者术前采用DFMA作为截骨角(研究组),另外64例采用传统股骨远端外翻5°截骨术(对照组),对比两组患者的手术时间、手术出血量、术后不同时间的膝关节活动度(ROM)、膝关节功能(HSS)和下肢力线的变化。结果研究组患者的手术时间、手术出血量与对照组比较,差异无统计学意义(P>0.05);术前,两组患者的膝关节ROM测定值差异无统计学意义(P>0.05);术后3个月、术后6个月,研究组患者的膝关节ROM测定值均高于对照组(P<0.05);术后6个月,研究组患者的膝关节功能评价优于对照组(P<0.05);术前,两组患者的下肢力线、假体力线测定值差异无统计学意义(P>0.05);术后3个月,研究组的下肢力线、假体力线测定值均显著低于对照组(P<0.05)。结论 DFMA作为股骨远端外翻截骨角测定法在TKA手术中有利于股骨假体冠状面位置达到最佳,有利于术后患者膝关节功能和下肢力线的恢复。

Objective To investigate the applicability of the distal femoral 1/3 anatomical axis and femoral force axis angle（ DFMA） as a measure of the distal femoral valgus osteotomy angle in knee arthroplasty（ TKA） surgery. Methods One hundred and thirty-four cases（ 134 knees） treated in our hospital between January 2015 and December 2016 were selected as the subjects. DFMA was used as the angle of the osteotomy（ study group） in seventy of these cases while the traditional distal femoral valgus 5 degree osteotomy was adopted in the rest of the patients（ control group）. The duration of surgery,amount of pereoperative bleeding and changes after operation were compared between the two groups. The changes of knee joint mobility（ ROM）,knee joint function（ HSS） and lower limb force line were recorded. Results The duration of surgery and blood loss of the study group were not statistically different from those of the control group（ P〉0.05）. The difference in knee ROM between the two groups was not statistically significant（ P〉0.05）. Three months and 6 months after operation,the knee ROM of the study group was higher than that of the control group（ P〈0. 05）. Knee function evaluation was better in the study group after 6 months than in the control group（ P〈0.05）. The difference of measured values of force lines and prosthesis lines between the two groups of patients was not statistically significant before operation（ P〉0.05）. However,three months after surgery,the lower-limb force lines and measured values of false physical lines in the study group were significantly lower than those of the control group（ P〈0.05）.Conclusion DFMA as a distal femoral valgus osteotomy angle measurement in TKA surgery is conducive to the best position of the femoral prosthesis coronal plane,playing an important role in postoperative knee function recovery and lower limb line recovery of patients.