膝关节外翻畸形来源的研究进展

Review on the origin of knee valgus deformity

对较常见的膝关节外翻畸形的来源进行分类,有利于更好地规划膝关节畸形的矫形方法、匹配假体与修复软组织。在分析临床典型病例的基础上,结合分类标准在实际临床中的可操作性进行甄别,建立合理的膝关节外翻畸形形态学分类,对掌握外翻畸形的发病特点和规律有重要意义。按畸形来源和内、外侧副韧带的张力情况分析膝关节外翻畸形分类方法,可将其分为传统型膝外翻畸形来源分类和新型膝外翻畸形来源分类。两者虽均着重突出了外翻畸形的骨性特点和软组织情况,但有较大区别。传统分类通过股胫角、外翻角等进行划分;新型分类以机械角、解剖角、股骨远髁角等进行划分。膝外翻畸形来源一般具有复合性,传统分类不能完全反映外翻畸形的畸形来源和软组织的张力状态,而新型分类,尤其是基于解剖角外翻畸形的分类不仅可反映膝关节外翻畸形的形态解剖学细节,还可反映决定膝关节稳定性的内、外侧副韧带的张力情况及局部软组织应力状态。目前临床常用的针对膝关节外翻畸形的手术方法包括膝关节周围截骨和全膝关节置换术,前者重在矫正关节外畸形,无需对韧带进行过度修复,而后者重在力线修正,是终末期外翻畸形的最终治疗方式。数字化技术在临床骨科的应用可提高内植物的置入准确度。

The sources of common knee valgus deformities were classified in order to better plan the orthopedic methods,matching prostheses and soft tissue repair of knee valgus deformities.Based on the analysis of typical clinical cases and the operability of classification standards in practical clinical practice,it is of great significance to establish a reasonable morphological classification of knee valgus deformity,in order to grasp the characteristics and patterns of the onset of valgus deformity.According to the origin of the deformity and the tension of the medial and lateral collateral ligaments,the classification of the genu valgus deformity can be divided into the classification of the traditional Genu valgum deformity origin and the classification of the new Genu valgum deformity origin.Although both of them highlight the skeletal characteristics and soft tissue conditions of the valgus deformity,they are quite different.Traditional classification is based on femoral tibial angle,valgus angle,etc;The new classification is divided into mechanical angle,anatomical angle,distal condylar angle,etc.The origin of Genu valgum deformity is generally complex.The traditional classification cannot fully reflect the origin of valgus deformity and the tension state of soft tissue.The new classification,especially based on the classification of anatomical angle valgus deformity,can not only reflect the morphological and anatomical details of knee valgus deformity,but also reflect the tension state of the medial and lateral collateral ligaments and local soft tissue stress state that determine the stability of the knee joint.At present,the commonly used surgical methods for valgus deformity of the knee include periarticular osteotomy of the knee and total knee Joint replacement.The former focuses on correcting extraarticular deformity without over repairing ligaments,and the latter focuses on force line correction,which is the final treatment for terminal valgus deformity.The application of digital technology in clinical orthopedics can improve the accuracy of implant placement.Implant placement needs to be based on the patient's bone characteristics and degree of deformity.For patients with severe deformity,the application of digital technology can improve the accuracy of implant placement and assist in the treatment of knee valgus deformity.