后稳定型假体联合髁限制垫片在中重度膝外翻畸形全膝关节置换术中的应用

Application of constrained condylar knee prosthesis combined with a posterior stabilized articular surface in total knee arthroplasty for patients with moderate or severe valgus knee

目的观察后稳定型假体联合髁限制垫片在中重度膝外翻畸形全膝关节置换术中应用的效果。方法回顾性分析自2018-09—2021-02完成的32例中重度膝外翻畸形初次全膝关节置换术,术中所有患者间隙无法平衡或使用普通加厚垫片后膝关节仍不稳定,应用后稳定型假体与髁限制垫片。比较术前与末次随访时股胫角、膝关节活动度、KSS评分。结果32例均获得随访,随访时间平均15.5(6~30)个月。随访期间均未出现膝关节感染、膝关节不稳、髌骨轨迹不良及假体松动等并发症。2例术后当天出现腓总神经麻痹症状,立即屈膝位放置患肢,其中1例当天症状消失,1例术后3周症状消失。4例残留轻度膝外翻(髋膝踝角为3°~6°),患者无膝关节不稳及疼痛症状。末次随访时股胫角较术前明显增大,膝关节活动度较术前明显增大,KSS评分较术前明显增加,差异有统计学意义(P<0.05)。结论中重度膝外翻畸形全膝关节置换术中应用后稳定型假体联合髁限制垫片能弥补术中韧带难以平衡带来的膝关节不稳,进而更好地矫正膝外翻畸形,疗效满意。

ObjectiveTo explore the treatment method and clinical effect of constrained condylar knee prosthesis combined with a posterior stabilized articular surface in total knee arthroplasty for patients with moderate or severe valgus knee.Methods A retrospective analysis was made of 32 cases of primary total knee arthroplasty for patients with moderate or severe valgus knee completed from September 2018 to February 2021.During the operation,all patients were unable to balance the space or the knee joint was still unstable after the use of ordinary thickened shims,and the constrained condylar knee prosthesis combined with a posterior stabilized articular surface was employed.The femoral tibial angle,knee joint range of motion and KSS score were compared before and at the last follow-up.ResultsAll 32 cases were followed up for an average of 15.5(6-30)months.During the follow-up period,there were no complications such as knee joint infection,knee joint instability,poor patellar track and prosthesis loosening.Two patients developed common peroneal nerve paralysis on the same day after operation,and the affected limb was immediately placed with flexion of the knee,of which one patient's symptoms disappeared on the same day,and another's symptoms disappeared 3 weeks after operation.There were 4 patients with residual mild knee valgus(hip,knee and ankle angle of 3°-6°).The patients had no knee instability and pain symptoms.At the last follow-up,the femoral and tibial angles were significantly larger than before operation,the range of motion of the knee joint was significantly larger than before operation,and the KSS score was significantly higher than before operation,the difference was statistically significant(P<0.05).Conclusion Total knee arthroplasty for moderate or severe valgus knee patients,using constrained condylar knee prosthesis combined with a posterior stabilized articular surface can timely make up for the joint instability caused by the difficult balance of ligament during operation,and better correct the valgus deformity.The postoperative curative effect is satisfactory.