外侧入路联合股骨外髁滑移截骨治疗膝外翻

Lateral Approach Combined with Lateral Femoral Sliding Osteotomy to Treat Valgus Knee

目的介绍膝外侧入路联合股骨外髁滑移截骨治疗膝外翻的临床疗效。方法回顾性分析2016年2月至2018年4月洛阳正骨医院采用外侧入路联合外髁滑移截骨行全膝关节置换治疗的膝外翻患者22例,男6例,女16例;年龄58~78岁,平均年龄(67.5±7.9)岁。记录手术时间、术中出血量、术后住院时间、并发症等情况,将随访时的影像学和临床参数与术前参数进行比较。结果所有患者均顺利完成手术,均选用后交叉韧带代替型(posterior stabilized,PS)膝关节假体,无一使用高限制性假体及铰链膝,手术时间(90.2±12.3)min,术中出血量(150.0±34.7)mL;随访24~63个月,平均随访(40.2±10.7)个月;术前美国膝关节协会评分(knee society score,KSS)、西大略湖麦克马斯特大学(the Western Ontario and McMaster Universities,WOMAC)关节炎指数评分、膝关节活动度(range of motion,ROM)分别为(45.5±10.3)分、(77.1±9.7)分、(77.3±6.3)°;术前髋膝踝角(hip knee ankle angle,HKA)和股骨远端机械轴外侧角(mechanical lateral distal femoral angle,mLDFA)分别为(193.6±7.5)°、(97.0±3.1)°;末次随访所有患者KSS、WOMAC、ROM分别为(90.3±10.6)分、(37.6±7.5)分、(110.0±6.3)°,与术前相比差异均有统计学意义(P<0.05);术后HKA和mLDFA分别为(181.4±2.6)°、(87.5±2.9)°,与术前相比差异均有统计学意义(P<0.05)。末次随访所有外侧股骨截骨块均愈合。结论外侧入路联合股骨外髁滑移截骨治疗膝外翻临床效果满意,术中不增加假体限制性。

Objective To explore the clinical effect of lateral approach combined with lateral femoral sliding osteotomy in valgus knee.Methods Retrospectively reviewed 22 patients diagnosed as valgus knee were treated with total knee arthroplasty by lateral approach combined with lateral femoral sliding osteotomy at Luoyang Orthopedic-Traumatological Hospital from February 2016 to April 2018.There were 6 males and 16 females.The patients aged from 58 to 78 years,with an average age of(67.5±7.9)years.The surgical time,perioperative blood loss,length of hospital stay,complications were recorded,and the radiographic anteroposterior view of the knee and clinical outcomes at last follow-up were compared with that before surgery.Results All patients were inserted with posterior stabilized(PS)prosthesis.No constrained and hinged prosthesis were used.The surgical time was(90.2±12.3)min,and the intraoperative blood loss was(150.0±34.7)ml.The followed up time was 24 to 63 months(mean,40.2±10.7 months).Preoperative knee society score(KSS),Western Ontario McMaster Universities(WOMAC),and range of motion(ROM)were(45.5±10.3),(77.1±9.7),(77.3±6.3)°,respectively.Preoperative hip knee ankle angle(HKA)and mechanical lateral distal femoral angle(mLDFA)were(193.6±7.5)°,(97.0±3.1)°,respectively.The KSS,WOMAC,ROM at last follow-up were(90.3±10.6),(37.6±7.5),(110.0±6.3)°,respectively,which were significantly better than those of pre-operation(P<0.05).The postoperative HKA and mLDFA were(181.4±2.6)°,(87.5±2.9)°respectively,which were significantly improved than those of pre-operation(P<0.05).Conclusion Lateral approach combined with lateral femoral sliding osteotomy is effective in the treated with valgus knee,without the needed of high grade of constraint of the implant during TKA.