保留后交叉韧带膝关节置换术治疗胫骨固有内翻膝骨关节炎的近期疗效

Short⁃term Effectiveness of Cruciate⁃retaining Total Knee Arthroplasty on Advanced Knee Osteoarthritis with Tibia Vara

目的探讨保留后交叉韧带膝关节置换术(cruciate⁃retaining total knee arthroplasty,CR⁃TKA)治疗胫骨固有内翻膝骨关节炎的近期临床疗效。方法回顾性分析2018年5月至2020年12月在我科行胫骨固有内翻的CR⁃TKA的病人48例(内翻组),男23例,女25例;年龄为(64.21±5.73)岁(53~79岁)。匹配同期实施CR⁃TKA的胫骨正常病人48例(对照组),男22例,女26例;年龄为(65.60±5.20)岁(56~77岁)。所有病人手术均由我科同一高年资主任医师完成,记录手术时间、术中出血量、术后下地时间和并发症等,比较术前和末次随访病人的膝关节疼痛视觉模拟量表(visual analogue scale,VAS)评分、美国膝关节协会评分(Knee Society Score,KSS)、牛津膝关节评分(Oxford Knee Score,OKS)、活动度(range of motion,ROM)、髋膝踝角(hip knee ankle,HKA)、机械轴股骨远端外侧角(mechanical lateral dis⁃tal femoral angle,mLDFA)、机械轴胫骨近端内侧角(mechanical medial proximal tibial angle,mMPTA)及关节线汇聚角(joint line convergence angle,JLCA)等。结果所有病例均获得随访,内翻组随访(27.69±9.92)个月,对照组随访(28.13±8.12)个月。两组的手术时间、术中出血量和术后下地时间比较,差异均无统计学意义(P>0.05)。两组术后VAS、KSS、OKS评分及ROM均较术前得到明显改善,差异均有统计学意义(P<0.05)。两组影像学测量HKA、mMPTA提示术后膝关节内翻、胫骨内翻均得到不同程度矫正,手术前后数据比较,差异均有统计学意义(P<0.05)。末次随访时,两组病人VAS、KSS、OKS评分及ROM比较,差异无统计学意义(P>0.05),且两组无感染、假体松动、僵硬及不稳等并发症。结论CR⁃TKA可以显著改善胫骨固有内翻膝骨关节炎病人近期膝关节疼痛和功能,是治疗胫骨固有内翻膝骨关节炎的有效方法。

Objective To investigate the short⁃term effectiveness of cruciate⁃retaining total knee arthroplasty on advanced knee osteoarthritis with tibia vara.Methods A total of 48 patients including 23 males and 25 females were followed up whom were taken cruciate⁃retaining total knee arthroplasty for advanced knee osteoarthritis with tibia vara in our department from May 2018 to December 2020(tibia vara group).The age was(64.21±5.73)years(53⁃79 years).A total of 48 cases of CR⁃TKA for advanced knee osteoarthritis without tibia vara were matched contemporaneously(control group),and the age was(65.60±5.20)years(56⁃77 years).All the operations were taken by the same senior surgeon in our department.The operation time,bleeding loss and ambulation time were recorded.The treatment was evaluated by visual analogue scale(VAS),Knee Society score(KSS)and Oxford knee score(OKS),range of motion(ROM),mechanical medial proximal tibial angle(mMPTA),mechanical lateral distal femoral angle(mLDFA),joint line convergence angle(JLCA)and hip knee ankle(HKA).Results All the cases in both groups were followed up for(27.69±9.92)months(tibia vara group)and(28.13±8.12)months(control group)respectively.There was no statistically significant difference in operation time,blood loss and ambulation time between two groups(P>0.05).The VAS,KSS,OKS and ROM in both groups were improved significantly after the surgery(P<0.05).The HKA and mMPTA were corrected with statistically significant difference in both groups by CR⁃TKA(P<0.05).At the end point of follow⁃up,there were no significant differences in VAS,KSS,OKS and ROM between two groups(P>0.05),and no infection,prosthesis loosening,stiffness and laxity occurred.Conclusion Cruciate⁃retaining total knee arthroplasty can significantly improve short⁃term pain and function of advanced knee osteoarthritis with tibia vara,which is an effective treatment for the treatment of advanced knee osteoarthritis with tibia vara.