CAJ | 학술논문

背景：全膝关节置换治疗膝关节骨性关节炎合并关节外畸形目前仍面临挑战，为获得良好的力线及恢复恰当的软组织平衡，需制定个体化的置换方案。目的：观察个体化设计一期关节置换治疗膝骨关节炎合并同侧股骨关节外畸形安全及可行性。方法：纳入膝骨关节炎合并同侧股骨关节外畸形患者8例，根据置换前计划，5例患者进行关节内代偿截骨治疗，3例患者行关节外矫正截骨，记录肢体多平面畸形和软组织条件。主要评估指标包括 HSS评分，WOMAC评分和力线偏差。结果与结论：平均随访29个月，患者HSS评分从置换前32.5分提高至置换后87.5分，WOMAC从置换前的37.1分提高到置换后88.8分(P<0.05)。力线偏差(无论是内翻或外翻)由置换前的17.1°变到置换后1.4°(P <0.05)。所有患者关节外矫正截骨的病理3个月内截骨端愈合，无置换后感染，假体松动或静脉血栓栓塞事件发生，仅1例患者残留5°膝过伸。结果证实，依据个体化的置换前计划，一期全膝关节置换治疗膝关节骨性关节炎合并同侧股骨关节外畸形安全有效。
배경：전슬관절치환치료슬관절골성관절염합병관절외기형목전잉면림도전，위획득량호적력선급회복흡당적연조직평형，수제정개체화적치환방안。목적：관찰개체화설계일기관절치환치료슬골관절염합병동측고골관절외기형안전급가행성。방법：납입슬골관절염합병동측고골관절외기형환자8례，근거치환전계화，5례환자진행관절내대상절골치료，3례환자행관절외교정절골，기록지체다평면기형화연조직조건。주요평고지표포괄 HSS평분，WOMAC평분화력선편차。결과여결론：평균수방29개월，환자HSS평분종치환전32.5분제고지치환후87.5분，WOMAC종치환전적37.1분제고도치환후88.8분(P<0.05)。력선편차(무론시내번혹외번)유치환전적17.1°변도치환후1.4°(P <0.05)。소유환자관절외교정절골적병리3개월내절골단유합，무치환후감염，가체송동혹정맥혈전전새사건발생，부1례환자잔류5°슬과신。결과증실，의거개체화적치환전계화，일기전슬관절치환치료슬관절골성관절염합병동측고골관절외기형안전유효。
BACKGROUND:Total knee arthroplasty for knee osteoarthritis accompanied with extra-articular deformity is stil chal enging. An individual replacement plan should be designed to obtain good mechanical axis and to recover suitable soft-tissue balance. OBJECTIVE:To observe the safety and feasibility of individual y designed one-stage total knee arthroplasty for knee osteoarthritis combined with ipsilateral femoral extra-articular deformity. METHODS:A total of eight patients with knee osteoarthritis combined with ipsilateral femoral extra-articular deformity were enrol ed in this study. According to preoperative plan, five patients underwent intra-articular compensatory osteotomy, and the remaining three received extra-articular corrective osteotomy. Multi-planar deformities as wel as soft-tissue conditions were recorded. Main outcome measures included the hospital for special surgery score, Western Ontario and McMaster Universities Arthritis Index score and alignments deviation. RESULTS AND CONCLUSION:The patients were averagely fol owed up for 29 months. The hospital for special surgery score changed from preoperative 32.5 points to postoperative 87.5 points. The Western Ontario and McMaster Universities Arthritis Index score was increased from preoperative 37.1 points to postoperative 88.8 points (P<0.05). Mean mechanical axis deviation (either varus or valgus) changed from preoperative 17.1° to postoperative 1.4° (P<0.05). Al cases with extra-articular corrective osteotomy healed within 3 months, and none had postoperative infection, loosening or venous thromboembolic events. One patient was with 5° residual knee anti-sheets. Results verified that one-stage total knee arthroplasty procedures are effective in the treatment of knee osteoarthritis accompanied with ipsilateral femoral extra-articular deformity in accordance with individual preoperative plan.