髌旁外侧入路全膝关节置换术治疗严重膝外翻畸形效果观察

Effectiveness Observation of Total Knee Arthroplasty via Lateral Parapatellar Approach in Treatment of Patients with Severe Knee Valgus Deformity

目的探讨对严重膝外翻畸形经髌旁外侧入路行全膝关节置换术治疗的临床效果。方法选择2007年1月—2019年6月行全膝关节置换术的严重膝外翻畸形61例。根据手术入路方式分为观察组24例和对照组37例。观察组采用髌旁外侧入路,对照组采用髌旁内侧入路。比较2组手术相关情况,手术前后股胫角、膝关节美国纽约特种外科医院(HSS)评分、膝关节活动度及并发症发生率。结果与对照组比较,观察组手术时间更长、术中出血量更多(P<0.05)。观察组术后7 d疼痛目测类比评分低于对照组(P<0.05)。与术前比较,2组术后关节动活度、HSS评分均升高,股胫角度降低,且观察组关节活动度、HSS评分高于对照组(P<0.05)。2组术后并发症发生率比较差异无统计学意义(P>0.05)。结论对严重膝外翻畸形经髌旁外侧入路行全膝关节置换术可取得满意的临床疗效,明显增加了膝关节活动度,改善了膝关节功能,是严重膝外翻畸形行全膝关节置换术的首选入路方式。

Objective To analyze clinical effectiveness of total knee arthroplasty(TKA)via lateral parapatellar approach in treatment of patients with severe knee valgus deformity.Methods A total of 61 patients with severe knee valgus deformity who had undergone TKA between January 2007 and June 2014 were enrolled as research subjects,and the patients were divided into observation group(n=24)and control group(n=37)according to surgical approach methods.Observation group underwent operation via the parapatellar lateral approach,while control group underwent operation via the parapatellar inward approach.Surgery-related conditions,femorotibial angle(FTA),knee joint Hospital for Special Surgery(HSS)scores,knee joint active range of motion(ROM)as well as incidence rates of complications before and after operation were compared between two groups.Results Compared with those in control group,the observation group had longer operative duration and more intraoperative volume of blood loss(P<0.05).Visual analogue scales(VAS)score of pain in observation group was significantly lower than that in control group after operation for 7 d(P<0.05).Compared with those before operation,the postoperative ROM and HSS scores were significantly increased,while the FTA values were significantly decreased in two groups;the knee joint ROM and HSS scores in observation group were significantly higher than those in control group(P<0.05).No significant difference was found in incidence rate of postoperative complications between two groups(P>0.05).Conclusion TKA via lateral parapatellar approach in treatment of patients with severe knee valgus deformity may achieve satisfactory clinical effectiveness,significantly increases ROM of the knee joint and improve the function of the knee joint.Therefore,it is the first choice for knee arthroplasty in treatment of patients with severe knee valgus deformity.