中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2014年
6期
645-651
,共7页
任姜栋%张晓岗%曹力%吾湖孜·吾拉木%郭文涛%彭理斌
任薑棟%張曉崗%曹力%吾湖孜·吾拉木%郭文濤%彭理斌
임강동%장효강%조력%오호자·오랍목%곽문도%팽리빈
关节成形术,置换,膝%膝外翻%骨关节炎%关节炎,类风湿
關節成形術,置換,膝%膝外翻%骨關節炎%關節炎,類風濕
관절성형술,치환,슬%슬외번%골관절염%관절염,류풍습
Arthroplasty,replacement,knee%Genu valgum%Osteoarthritis%Arthritis,rheumatoid
目的 探讨重度膝关节外翻畸形全膝关节置换术的手术方法及临床效果.方法 对2007年1月至2012年12月采用全膝关节置换治疗的重度膝关节外翻畸形患者22例(23膝)进行回顾性分析.男7例,女15例;年龄41~78岁,平均65岁.股胫角(股骨和胫骨解剖轴线的夹角)22°~50°,平均为34.6°.骨关节炎17例,类风湿关节炎5例.髌骨完全脱位3例3膝,内侧不稳定1例1膝,屈曲挛缩畸形3例4膝.21例22膝采用后稳定型假体,1例1膝采用限制型假体.髌旁内侧入路、常规截骨及单纯外侧软组织松解,术中行髌骨置换5例.以膝关节活动度、X线股胫角及美国特种外科医院(Hospital for Special Surgery,HSS)膝关节评分评价术后疗效.结果 全部病例随访时间1~5年,平均2.5年.膝关节活动度由术前平均43.7°±5.8°(0°~80°)提高至末次随访时110.6°±7.5°(80°~130°),HSS膝关节评分由术前平均(19.6±4.7)分(6~34分)提高至末次随访时(89.7±3.6)分(84~96分),手术前后的差异有统计学意义.外翻畸形基本得到矫正,末次随访时股胫角平均为8.6°±0,8°(0°~12°),较术前34.6°±2.4°(22°~50°)明显改善,手术前后的差异有统计学意义.术后2例2膝有膝关节内侧不稳症状,给予膝关节支具保护;1例1膝术前严重髌骨脱位患者术后存在半脱位,未予特殊处理;2例2膝术后出现腓总神经麻痹,未予特殊处理.随访期间未发生感染、松动及深静脉血栓形成等并发症.结论 对重度膝关节外翻畸形患者可采用常规截骨、单纯外侧软组织松解及后稳定型假体植入,能较好地矫正外翻畸形,近期疗效满意.
目的 探討重度膝關節外翻畸形全膝關節置換術的手術方法及臨床效果.方法 對2007年1月至2012年12月採用全膝關節置換治療的重度膝關節外翻畸形患者22例(23膝)進行迴顧性分析.男7例,女15例;年齡41~78歲,平均65歲.股脛角(股骨和脛骨解剖軸線的夾角)22°~50°,平均為34.6°.骨關節炎17例,類風濕關節炎5例.髕骨完全脫位3例3膝,內側不穩定1例1膝,屈麯攣縮畸形3例4膝.21例22膝採用後穩定型假體,1例1膝採用限製型假體.髕徬內側入路、常規截骨及單純外側軟組織鬆解,術中行髕骨置換5例.以膝關節活動度、X線股脛角及美國特種外科醫院(Hospital for Special Surgery,HSS)膝關節評分評價術後療效.結果 全部病例隨訪時間1~5年,平均2.5年.膝關節活動度由術前平均43.7°±5.8°(0°~80°)提高至末次隨訪時110.6°±7.5°(80°~130°),HSS膝關節評分由術前平均(19.6±4.7)分(6~34分)提高至末次隨訪時(89.7±3.6)分(84~96分),手術前後的差異有統計學意義.外翻畸形基本得到矯正,末次隨訪時股脛角平均為8.6°±0,8°(0°~12°),較術前34.6°±2.4°(22°~50°)明顯改善,手術前後的差異有統計學意義.術後2例2膝有膝關節內側不穩癥狀,給予膝關節支具保護;1例1膝術前嚴重髕骨脫位患者術後存在半脫位,未予特殊處理;2例2膝術後齣現腓總神經痳痺,未予特殊處理.隨訪期間未髮生感染、鬆動及深靜脈血栓形成等併髮癥.結論 對重度膝關節外翻畸形患者可採用常規截骨、單純外側軟組織鬆解及後穩定型假體植入,能較好地矯正外翻畸形,近期療效滿意.
목적 탐토중도슬관절외번기형전슬관절치환술적수술방법급림상효과.방법 대2007년1월지2012년12월채용전슬관절치환치료적중도슬관절외번기형환자22례(23슬)진행회고성분석.남7례,녀15례;년령41~78세,평균65세.고경각(고골화경골해부축선적협각)22°~50°,평균위34.6°.골관절염17례,류풍습관절염5례.빈골완전탈위3례3슬,내측불은정1례1슬,굴곡련축기형3례4슬.21례22슬채용후은정형가체,1례1슬채용한제형가체.빈방내측입로、상규절골급단순외측연조직송해,술중행빈골치환5례.이슬관절활동도、X선고경각급미국특충외과의원(Hospital for Special Surgery,HSS)슬관절평분평개술후료효.결과 전부병례수방시간1~5년,평균2.5년.슬관절활동도유술전평균43.7°±5.8°(0°~80°)제고지말차수방시110.6°±7.5°(80°~130°),HSS슬관절평분유술전평균(19.6±4.7)분(6~34분)제고지말차수방시(89.7±3.6)분(84~96분),수술전후적차이유통계학의의.외번기형기본득도교정,말차수방시고경각평균위8.6°±0,8°(0°~12°),교술전34.6°±2.4°(22°~50°)명현개선,수술전후적차이유통계학의의.술후2례2슬유슬관절내측불은증상,급여슬관절지구보호;1례1슬술전엄중빈골탈위환자술후존재반탈위,미여특수처리;2례2슬술후출현비총신경마비,미여특수처리.수방기간미발생감염、송동급심정맥혈전형성등병발증.결론 대중도슬관절외번기형환자가채용상규절골、단순외측연조직송해급후은정형가체식입,능교호지교정외번기형,근기료효만의.
Objective To investigate the surgical methods and clinical effects of total knee arthroplasty (TKA) in patients with severe valgus knee deformity.Methods From January 2007 to December 2012,22 patients with 23 severe valgus knee deformity underwent TKA by means of medial parapatellar approach,standard osteotomy and only lateral soft tissue release with posterior stabilized implants were retrospectively analyzed.They were 7 males and 15 females,aged from 41 to 78 years,with an average age of 65 years.Tibiofemoral angle (angle between the femur and tibia anatomic axis) was 22°-50°,with an average of 34.6±2.4°.Among them,17 cases were osteoarthritis,5 cases were rheumatoid arthritis,3 cases complicated with patella dislocations,1 case complicated with medial instability,3 cases of 4 knees complicated with flexion contracture.Posterior stabilized prosthesis were used in 21 cases of 22 knees,constrained prosthesis were used in 1 case of 1 knee,5 cases accepted intraoperative patellar replacement.Clinical and radiographic evaluations including range of motion (ROM),the Hospital for Special Surgery (HSS)knee score and the tibial and femur angle (T-F angle) were performed at follow-up.Results The duration of follow-up averaged 30.5 months.The average HSS score improved from 19.6±4.7 points preoperatively to 89.7±3.6 points at the time of the last follow up.The average ROM improved from 43.7°-±5.8° preoperatively to 110.6°±7.5°.The average T-F angle was 8.6°±0.8°.We had 5 patella replacements,2 medial instability cured by using articular branches,2 palsies of nervus peroneus communis recovering after 3 months.No complications such as infection,DVT,or component loosening.Conclusion The techniques of medial parapatellar approach,standard osteotomy and only lateral soft tissue release with posterior stabilized implants can deal with a severe valgus knee deformity very successfully in patients undergoing primary total knee arthroplasty,and provide excellent results.