膝内翻畸形对全膝置换术手术前后踝关节的影响研究

Effect of knee varus deformity on the ankle before and after total knee arthroplasty

目的探究膝内翻畸形患者下肢力线与踝关节对线、对位不良之间相关性,并评估经全膝关节置换术(total knee arthroplasty,TKA)矫正畸形后踝关节对线、对位的改变。方法对2019年6~12月于广州中医药大学附属中山中医院行TKA治疗膝关节骨关节炎的80例内翻膝患者的术前及术后末次随访的站立位双下肢全长DR片上膝、踝关节的力线及角度进行测量并分析;测量角度包括髋关节-膝-踝关节角(the hip-knee-ankle angle,HKA)、胫距角(tibial anterior surface angle,TAS)、胫骨远端外侧角(lateral distal tibial angle,LDTA)、距骨倾斜角(talar tilt angle,TT)、距骨解剖角(anatomical talocrural angle,TC)、胫骨平台与胫骨远端关节面间的角度(the tibial plateau and distal tibial plafond angle,PP)、地面与胫骨远端关节面间的角度(angles between the ground surface and distal tibial plafond,GP)、地面与上距骨关节面间的角度(angles between the ground surface and upper talus,GT);对其中合并同侧踝关节疼痛者,术前与术后采用视觉模拟评分(visual analogue scale,VAS)进行记录。结果Wilcoxon配对秩和检验、Spearman秩相关检验分析显示,术前HKA与GP、GT之间存在显著相关性(P<0.05),术前膝内翻畸形导致的不良下肢力线可影响踝关节的倾斜;术后HKA与GP、GT之间存在显著相关性(P<0.05),术前与术后末次随访所测HKA、PP、GP、GT、TT、TAS之间差异均有统计学意义(P<0.05),TKA术后踝关节的倾斜及对位不良随着下肢力线的纠正发生变化,术前合并同侧踝关节疼痛患者术后疼痛改善(P<0.05)。结论膝关节内翻畸形可对踝关节对线及对位造成影响。通过TKA矫正膝内翻畸形后,踝关节的对位不良及倾斜可得到改善,同侧踝关节疼痛得到缓解。

Objective To investigate the correlations between the lower limb alignment and malalignment of the ankle joint in patients with knee varus,and to evaluate the changes of alignment after total knee arthroplasty(TKA).Methods Between June and December 2019,data of 80 patients with osteoarthritic knee varus treated with TKA at Zhongshan Hospital of Traditional Chinese Medicine affiliated to Guangzhou University of Chinese Medicine were retrospectively analyzed.The force line and angle of the knee and ankle were measured and analyzed based on the full-length DR radiographs of double lower limbs in standing position before operation and at the last follow-up.Angles including the hip-knee-ankle angle(HKA),tibial anterior surface angle(TAS),lateral distal tibial angle(LDTA),talar tilt angle(TT),anatomical talocrural angle(TC),tibial plateau and distal tibial plafond angle(PP),angles between the ground surface and distal tibial plafond(GP)and angles between the ground surface and upper talus(GT)were measured.The patients with ipsilateral bilateral ankle pain were evaluated with visual analogue scale(VAS)before and after operation.Results Wilcoxon paired rank sum test and Spearman rank correlation test showed significant correlations between HKA and GP,GT before and after operation(P<0.05);alignment of the knee varus deformity could affect the inclination of the ankle.The changes of HKA,PP,GP,GT,TT and TAS after operation were statistically significant compared with those before operation(P<0.05).The deviation and malalignment of ankle changed with the correction of lower limb alignment after TKA.The postoperative pain was improved in patients with ipsilateral ankle pain before operation(P<0.05).Conclusions Knee varus deformity will affect the force line and alignment of the ankle.The malalignment and tilt of the ankle will be improved along with the correction of knee varus deformity by TKA.Meanwhile,the ipsilateral ankle pain can be alleviated.