CAJ | 학술논문

背景：内外翻限制性衬垫严格遵循“以最低的限制性获得可靠的稳定性”的原则，在提高假体的稳定性的同时又不增加限制级别。 　　目的：回顾性分析限制性衬垫在老年初次膝关节置换中内外翻不稳定的应用经验，总结限制性衬垫使用的适应证及临床效果。 　　方法：2010年3月至2012年3月间收治合并膝内外翻畸形的70例初次膝关节置换老年病例，其中内翻56例(平均15°-30°)；外翻14例(平均10°-20°)。70例中在完成标准截骨和软组织平衡操作后出现一侧<6 mm内外翻不稳定的23例(25膝)使用了限制性衬垫，其中内翻不稳18膝，外翻不稳7膝。23例均使用施乐辉公司普通骨水泥型膝关节假体，均未使用假体延长柄，11膝术中使用了骨水泥或自体骨植骨填补骨缺损。 　　结果与结论：平均随访2年(18-42个月)，所有病例膝关节疼痛消失，关节稳定，下肢力线纠正，KSS评分从置换前平均39.4分，提高到置换后的平均88.5分。所有患者均无需膝关节支具保护，膝关节最大屈曲度平均110°(96°-130°)，SF-36问卷满意度98%，无感染及脱位等并发症。结果提示在膝关节置换时完成截骨和软组织平衡后出现<6 mm内外翻不稳定时使用限制性衬垫，在老年初次膝关节置换中可以保留骨量，简化手术操作，近期临床效果良好。
배경：내외번한제성츤점엄격준순“이최저적한제성획득가고적은정성”적원칙，재제고가체적은정성적동시우불증가한제급별。 　　목적：회고성분석한제성츤점재노년초차슬관절치환중내외번불은정적응용경험，총결한제성츤점사용적괄응증급림상효과。 　　방법：2010년3월지2012년3월간수치합병슬내외번기형적70례초차슬관절치환노년병례，기중내번56례(평균15°-30°)；외번14례(평균10°-20°)。70례중재완성표준절골화연조직평형조작후출현일측<6 mm내외번불은정적23례(25슬)사용료한제성츤점，기중내번불은18슬，외번불은7슬。23례균사용시악휘공사보통골수니형슬관절가체，균미사용가체연장병，11슬술중사용료골수니혹자체골식골전보골결손。 　　결과여결론：평균수방2년(18-42개월)，소유병례슬관절동통소실，관절은정，하지력선규정，KSS평분종치환전평균39.4분，제고도치환후적평균88.5분。소유환자균무수슬관절지구보호，슬관절최대굴곡도평균110°(96°-130°)，SF-36문권만의도98%，무감염급탈위등병발증。결과제시재슬관절치환시완성절골화연조직평형후출현<6 mm내외번불은정시사용한제성츤점，재노년초차슬관절치환중가이보류골량，간화수술조작，근기림상효과량호。
BACKGROUND:Valgus-varus constrained polyethylene insert is selected in strict accordance with the principle of“to obtain reliable stability using minimum restriction”. The stability of the prosthesis is elevated, but the restriction is not increased. OBJECTIVE:To retrospectively analyze the application experience of constrained polyethylene insert in valgus and varus instability of primary total knee arthroplasty for older patients and to summarize the indications and clinical effects of this kind of implements. METHODS:From March 2010 to March 2012, a total of 70 patients combined valgus and varus malfomation who accepted primary total knee arthroplasty were enrol ed in this study, including 56 varus patients (averagely 15°-30°) and 14 valgus patients (averagely 10°-20°). Constrained polyethylene insert was performed in 23 patients (25 knees) who stil had remaining unilateral valgus or varus<6 mm (18 patients were varus instability and 7 patients were valgus instability) when finished operation of standard osteotomy and soft tissue balancing. The bone cement knee prostheses in 23 cases were purchased from Smith&Nephew. The stem implant was not used in al cases. Cement or autografts were used in 11 valgus knees to fil the bone defects. RESULTS AND CONCLUSION:Patients were fol owed up for 2 years on average (18-42 mouths). The knee pain symptoms of al cases disappeared. The joint stability was obviously improved. The lower limb power lines were correct. The Knee Society Score scores were improved from an average of 39.4 points preoperation to an average of 88.5 points postoperation. Al cases did not need the protection of knee braces. The maximum degree of flexion was 110°(96°-130°). The satisfaction degree of 36-Item Short Form Health Survey was 98%. No dislocation or infection happened. Results indicated that constrained polyethylene insert could be applied in the cases of less than 6 mm valgus and varus instability when finished operation of standard osteotomy and soft tissue balancing in total knee arthroplasty for older patients. This kind of implements can preserve bone mass, simplify operational process and have good clinical outcome in a short period.