CAJ | 학술논문

背景：伴有关节外畸形的膝骨关节炎临床上并不常见，手术治疗难度较大，目前术式选择关节内代偿性截骨还是关节外截骨矫形后再行膝关节置换术尚存争议。 　　目的：探讨伴有关节外畸形的膝骨关节炎行全膝关节置换术（TKA）的方法、适应证和疗效。 　　方法：2001年4月至2007年2月行关节外截骨的TKA或关节内截骨的TKA治疗膝骨关节炎合并关节外畸形患者8例，男1例，女7例；年龄39~72岁，平均63.9岁。7例股骨畸形由骨折畸形愈合造成，1例胫骨畸形伴弓形股骨为代谢性骨病所致。 　　结果：全部获得随访，随访时间为7~13年，平均11年。HSS评分从术前11~48分，平均34.5分，提高至术后76~94分，平均87.0分。下肢机械轴线由术前平均内翻偏移14.6°改善至术后平均内翻偏移2.1°。未见感染，骨延迟愈合、不愈合，血栓栓塞等并发症，中远期疗效良好。 　　结论：伴有股骨关节外畸形的膝骨关节炎治疗难度较大，采用关节外截骨结合一期或二期TKA可有效恢复下肢机械轴线，获得满意的临床效果；如果关节内截骨的TKA使用传统手术器械，术后下肢机械轴线可能恢复不良。
배경：반유관절외기형적슬골관절염림상상병불상견，수술치료난도교대，목전술식선택관절내대상성절골환시관절외절골교형후재행슬관절치환술상존쟁의。 　　목적：탐토반유관절외기형적슬골관절염행전슬관절치환술（TKA）적방법、괄응증화료효。 　　방법：2001년4월지2007년2월행관절외절골적TKA혹관절내절골적TKA치료슬골관절염합병관절외기형환자8례，남1례，녀7례；년령39~72세，평균63.9세。7례고골기형유골절기형유합조성，1례경골기형반궁형고골위대사성골병소치。 　　결과：전부획득수방，수방시간위7~13년，평균11년。HSS평분종술전11~48분，평균34.5분，제고지술후76~94분，평균87.0분。하지궤계축선유술전평균내번편이14.6°개선지술후평균내번편이2.1°。미견감염，골연지유합、불유합，혈전전새등병발증，중원기료효량호。 　　결론：반유고골관절외기형적슬골관절염치료난도교대，채용관절외절골결합일기혹이기TKA가유효회복하지궤계축선，획득만의적림상효과；여과관절내절골적TKA사용전통수술기계，술후하지궤계축선가능회복불량。
Background: Knee osteoarthritis associated with severe extra-articular deformity is an uncommon clinical condition. The surgical treatments (intra-articular bone resection plus TKA or extra-articular osteotomy with TKA) is still in dispute. Objective:The purpose of this paper is to review our experience in TKA for treatment of osteoarthritis associated with se-vere extra-articular deformity, as well as to discuss operation indications and clinical outcomes. Methods:Eight patients with knee osteoarthritis and extra-articular deformity underwent TKA after extra-articular correc-tive osteotomy or intra-articular bone resection between April 2001 and February 2007. There were 1 male and 7 females aged from 39 to 72 years (mean 63.9 years). The deformity of femur in 7 cases resulted from malunion of fracture. The cause of tibial deformity and bow femur was metabolic bone disease in another patient. Results:The mean follow-up period was 11 years (ranged from 7 to 13 years). The mean HSS score at the last follow-up was 87 (range, 76-94), which was significantly higher than preoperative one (34.5, range 11-48). The average deviation of mechanical axis of lower limb was improved from preoperatively 14.6° of varus excursion to postoperatively 2.1° of varus excursion. No complications such as infection, delayed union, nonunion or DVT were found. Conclusions:Treatment for ipsilateral knee osteoarthritis associated with severe extra-articular deformity is technically diffi-cult. Extra-articular osteotomy with one-stage or two-stage TKA can effectively restore the mechanical axis of lower limb and a satisfied clinical result can be achieved. If traditional instruments were used in the procedure of intra-articular bone re-section and TKA, some errors may occur on the mechanical axis of lower limb postoperatively.