全膝关节置换术治疗膝关节骨性关节炎合并轻中度膝外翻畸形的疗效评价

Clinical effect of total knee arthroplasty on patients with knee osteoarthritis combined with mild to moderate valgus knee deformity

目的:探讨全膝关节置换术治疗膝关节骨性关节炎合并轻中度膝外翻畸形的手术技巧及临床疗效。方法:中南大学湘雅医院2011年1月至2014年2月收治15例膝关节骨性关节炎合并轻中度膝外翻畸形行人工全膝关节置换术治疗的患者,均采用后稳定型假体,应用髌旁内侧入路、骨赘清理、常规截骨、选择性软组织松解与平衡技术矫正膝外翻畸形,术后采取常规抗凝及对症的康复治疗。术前及术后摄取X线片测量患者股胫角(femor-Tibial angle,fTa),复查假体位置。采用目测类比评分(viSual analogue SCale,VaS)、fTa、疼痛评分及膝关节评分系统(knee SCoring SySTem,KSS)评价临床效果。结果:15例患者随访14~36(22.40±11.88)个月,无失访。本组患者住院时间7~13(7.73±1.58)d;手术时间58~110(81.80±16.85)min,显性失血量140~600(337.30±143.65)m l。置换术后有2例术后出现伸膝迟滞,经过功能锻炼后,膝关节活动度恢复。3例术后出现膝前痛,予以塞来昔布止痛治疗,术后3个月疼痛逐渐缓解。其中1例术后切口出现溢液、红肿,经换药后愈合。复查X线片,全组未出现假体松动、下沉等并发症。末次随访fTa(8.1±1.8)°,膝关节屈伸活动度(107.33±9.61)°,KSS功能评分和临床评分分别为(74.7±14.5),(75.3±2.7)分,疼痛评分(2.5±0.9)显著优于术前,差异有统计学意义(p<0.05)。KSS功能评分和临床评分优良率达到80%。结论:通过恰当的术中截骨和软组织松解平衡,采用髌骨内侧入路全膝关节置换术治疗合并轻中度膝外翻畸形的骨性关节炎可有效改善膝外翻畸形,临床疗效满意。

Objective: To investigate the clinical effect of total knee arthroplasty on patients with knee osteoarthritis combined with mild to moderate valgus knee deformity.Methods: A total of 15 patients received total knee arthroplasty for correcting mild(10°-15°) to moderate(15°-30°) valgus knee between January 2011 and February 2014 in Xiangya Hospital of Central South University. We adopted a stable prosthesis surgery through patellar medial approach, osteophytes cleaning, conventional osteotomy, a selective soft tissue release and balance technical correcting of knee valgus deformity. Then conventional anticoagulation and symptomatic rehabilitation was utilized. Preoperative and postoperative X-ray was conducted in patients with measuring femor-tibial angle(FTA) and inspecting the prosthesis position. FTA, visual analog scale(VAS) standard, and parallel knee scoring system(KSS) were used to evaluate the clinical effect.Results: Fifteen patients were followed up for 14 to 36(22.40±11.88) months. The hospitalization time was 7-13(7.73±1.58) d; operative time was 58-110(81.8±16.85) min, the dominant blood loss was 140-600(337.30±143.65) mL. Two cases had knee extension hysteresis, and the knee activity recovered after exercise. Leg power lines were normal. Three postoperative cases suffered anterior knee pain. They were subjected to celecoxib analgesic treatment and the pain gradually eased after 3 months. One postoperative case showed incision discharge and swelling, which was healed after change of dressing. During follow-up, review of X-ray film does not show prosthesis loose, subsidence and other complications. The knee valgus angle(8.1±1.8)°, knee motion range(107.33±9.61)°, KSS knee score(74.7±14.5, 75.3±2.7) and pain score(2.5±0.9) were significantly better than the preoperative(P<0.05). The clinical and function KSS scores showed that the improvement rate was 80%. Conclusion: Total knee arthroplasty is an effective way to treat patients with knee osteoarthritis combined with mild to moderate valgus knee deformity. The correction of deformity and improvement of joint function can be achieved significantly. The clinical result is satisfactory and patients' quality of life is improved.