人工全膝关节置换联合螺钉治疗重度膝内翻畸形合并胫骨平台沉降的临床疗效探讨

Clinical effect of total knee arthroplasty with screw on severe knee varus deformity with tibial plateau settlement

目的探讨人工全膝关节置换联合螺钉治疗重度膝内翻畸形合并胫骨平台沉降的临床疗效。方法2016-08~2019-01收治11例(16膝)内翻畸形合并胫骨平台沉降患者,均为女性,采用人工全膝关节置换手术治疗。根据X线片比较术前和术后膝内翻角度,应用术前膝关节学会评分系统(KSS)临床评分为(40.28±11.34)分、功能评分为(48.32±15.54)分,膝关节活动度(range of motion,ROM)为(89.76±14.13)°,胫股角(femoral tibia angle,FTA)为(15.04±3.38)°。结果手术时间为75~90 min,平均80 min;显性失血量为200~700 ml,平均430 ml;住院时间为10~15 d,平均12.5 d。随访时间为6~21个月,平均15个月。复查X线片测量膝关节FTA为(5.87±1.10)°,下肢力线均恢复正常。随访期间无假体松动、下沉。末次随访时,膝关节KSS临床评分为(87.33±5.42)分,功能评分为(89.45±5.94)分,膝关节ROM为(107.54±10.68)°,与术前比较差异有统计学意义(P<0.05)。结论对于膝内翻畸形合并胫骨平台沉降患者,人工全膝关节置换术后下肢力线恢复良好,螺钉联合骨水泥支撑小面积胫骨平台沉降,膝关节活动度、稳定性及功能恢复满意。

Objective To explore the clinical effect of total knee arthroplasty(TKA) with screw on severe knee varus deformity with tibial plateau settlement.Methods From August 2016 to January 2019, 11 female patients(16 knees) with knee varus deformity and tibial plateau subsidence were selected and were treated with TKA. According to the X-ray films, the preoperative and postoperative knee varus angles were compared. The clinical scores [(40.28±11.34)points], the function scores [(48.32±15.54)points], the range of motion(ROM) [(89.76±14.13)°], and the femoral tibia angles(FTAs) [(15.04±3.38)°] were scored or measured by Knee Society Scoring System(KSS).Results The operation time was 75~90 min, with an average of 80 min. The amount of dominant blood loss was 200~700 ml, with an average of 430 ml. The length of hospital stay ranged from 10 to 15 days, with an average of 12.5 days. The patients were followed up for 6 to 21 months, with an average of 15 months. The FTA of knee joint was(5.87±1.10) ° measured by reexamination of X-ray film, and axial alignment of the lower extremity recovered to normal. No loosening or sinking of prosthesis was found during the follow-up. At the time of the last follow-up, the clinical scores were(87.33±5.42)points;the function scores were(89.45±5.94)points and the ROM were(107.54±10.68)° using KSS;the differences were statistically significant compared with those before operation.Conclusion For the patients with knee varus deformity and tibial plateau settlement, the axial alignment of the lower extremity recovers well, and the settlement of small tibial plateau is supported by screws and cement. The range of motion, stability and functional recovery of the knee joints are satisfactory.