直接外侧结构松解术治疗重度膝关节外翻畸形

Correcting Severe Valgus Deformity with the Method of Direct Lateral Soft Structure Release in Total Knee Arthroplasty

目的探讨直接外侧结构[外侧副韧带(lateral collateral ligament,LCL)+腘肌腱(popliteus,Pop)+髂胫束(iliotibial band,ITB)]松解方法应用于重度膝关节外翻畸形患者人工全膝关节置换术(total knee arthroplasty,TKA)的临床效果。方法 2007年1月至2014年12月,新疆医科大学第一附属医院收治的因重度膝关节外翻畸形采用直接外侧结构松解方法行TKA手术的患者28例(30膝),其中男性8例,女性20例;年龄41~80岁,平均(66.7±11.1)岁;骨性关节炎23例,类风湿关节炎5例,合并髌骨完全脱位2例,内侧不稳定1例。28例(30膝)患者术中均采用直接外侧结构松解方法以获得膝关节平衡。仅2膝彻底松解了Pop,所有患者均松解了LCL和ITB。随访采用X线检查测量膝关节股胫角度数评价外翻改善程度,采用美国特种外科医院(the Hospital for Special Surgery,HSS)关节评分评估膝关节功能,采用双下肢站立位全长X线及膝关节正侧位X线检查测量下肢力线并评价假体位置。结果术后平均随访2~8年,HSS评分从术前(20.4±14.3)分(6~38分)提高至末次随访时(89.5±9.4)分(83~96分),P<0.001;股胫角由术前(32.6±4.3)°(22°~42°)降至末次随访时(7.6±3.7)°(0°~10°),P=0.001。术后1例患者膝关节外侧不稳,给予膝关节支具保护3个月后症状消失,4例术后出现腓总神经麻痹,术后3个月复查症状消失,未发生感染、松动、血栓等并发症。结论对于重度膝关节外翻畸形患者,按顺序直接外侧结构松解方法安装后稳定型假体,可取得满意的临床效果。

Objective This study aimed to investigate the clinical results of the method of direct lateral structure release in the treatment of severe valgus knee deformity with total knee arthroplasty(TKA).Methods Twenty-eight patients(30knees)with severe valgus knee deformity underwent TKA with the method of direct lateral soft tissue release with posterior stabilized implants from January2007to December2014.There were8males and20fem ales,with the ages ranging from41to80years[mean(66.7±11.1)years].There were23knees of osteoarthritis,5knees of rheumatoid arthritis,2knees of patella dislocation,and1knee of medial instability.Lateral collateral ligament(L C L)and iliotihial hand(IT B)were released in all patients,only2popliteus(P ops)were released.Clinical and radiographic evaluations including range of motion(R O M),the Hospital for Special Surgery(H SS)knee score,and the tihia and femur angle(T-F angle)were performed at follow-up.Results The duration of follow-up ranged2to8years.The average HSS score improved from20.4士14.3points preoperatively to89.5±9.4points at the final follow-up,P<0.001.The average T-F angle was corrected from32.6±4.3to7.6±3.7,P=0.001.We cured1case of lateral instability by using articular branches.4patients with palsy of peroneal nerve recovered after3months.There had been no complications,such as infectio n,DVT,or component loosening.Conclusions The techniques of direct lateral soft tissue release(LCL+Pop+ITB)with posterior stabilized implants can correct a sever valgus deformity very successfully in patients undergoing primary total knee arthroplasty,and provide excellent results.