人工全膝关节置换术中滑移截骨矫正重度外翻畸形的疗效观察

发布时间：2018-01-11 12:07

本文关键词：人工全膝关节置换术中滑移截骨矫正重度外翻畸形的疗效观察　出处：《中国修复重建外科杂志》2016年02期 　论文类型：期刊论文

【摘要】：目的探讨人工全膝关节置换术(total knee arthroplasty,TKA)中采用内侧副韧带起点向上滑移截骨矫正重度膝外翻畸形的手术技巧及疗效。方法 2008年6月-2014年2月,收治18例(19膝)伴重度膝关节外翻畸形拟行TKA患者。男6例,女12例;年龄29~72岁,平均52.3岁。关节置换原因:骨关节炎3例(3膝),类风湿性关节炎11例(12膝),创伤性关节炎3例(3膝),先天性发育畸形伴髌骨外脱位1例(1膝)。膝关节学会评分系统(KSS)侧方稳定性评分为(6.0±5.4)分,美国特种外科医院(HSS)评分为(41.6±7.7)分。X线片测量示胫股角为(33.0±2.9)°。根据Krackow膝外翻分型标准均为Ⅱ型。置换术中采用内侧副韧带起点向上滑移截骨恢复软组织平衡,矫正外翻畸形。结果术后切口均Ⅰ期愈合。1例术后发生腓总神经麻痹,予以对症支持治疗,6个月后完全恢复。18例(19膝)均获随访,随访时间19个月~7年,平均5.7年。X线片复查示,术后6个月截骨片均骨性愈合;随访期间假体位置良好,未发现松动、下沉;末次随访时胫股角为(4.8±1.8)°,与术前比较差异有统计学意义(t=62.61,P=0.00)。末次随访时,HSS评分为(87.2±10.5)分,KSS侧方稳定性评分为(12.4±3.1)分,均较术前显著提高,比较差异有统计学意义(t=—33.35,P=0.00;t=—6.83,P=0.00)。结论对于伴重度膝关节外翻畸形者,TKA术中通过内侧副韧带起点向上滑移截骨可恢复软组织平衡,矫正外翻畸形,获得满意的膝关节稳定性和关节功能。
[Abstract]:Objective To investigate the surgical technique and the curative effect of medial collateral ligament in total knee arthroplasty ( TKAs ) in patients with severe knee joint deformity . The results showed that there were 3 cases of osteoarthritis ( 3 knees ) , 11 cases of rheumatoid arthritis ( 12 knees ) , 3 cases of traumatic arthritis ( 3 knees ) , 1 case of rheumatoid arthritis ( 12 knees ) , 3 cases of traumatic arthritis ( 3 knees ) , 1 case of rheumatoid arthritis ( 12 knees ) , 3 cases of traumatic arthritis ( 3 knees ) , 1 case of rheumatic arthritis ( 12 knees ) , 3 cases of traumatic arthritis ( 3 knees ) , no loosening and subsidence at the time of follow - up . At the last follow - up , HSS score was ( 87.2 卤 10.5 ) , and the stability score of KSS side was ( 12.4 卤 3.1 ) , and the difference was statistically significant ( t = - 33.35 , P = 0.00 ; t = - 6.83 , P = 0.00 ) . Conclusion For patients with severe knee joint deformity , the knee joint stability and joint function can be obtained by sliding osteotomy from the origin of medial collateral ligament to recover the soft tissue balance and correct the deformity of the knee joint .

【作者单位】：四川大学华西医院骨科;
【基金】：卫生行业科研专项项目(201302007)~~
【分类号】：R687.4
【正文快照】： 目前,人工全膝关节置换术(total knee arthro-plasty,TKA)已广泛用于治疗晚期膝关节疾病,能有效改善关节功能,减轻疼痛。TKA成功的关键在于恢复下肢力线、关节线、韧带软组织平衡和髌骨运动轨迹[1]。然而对于膝关节重度外翻畸形者,其股骨外侧髁常发育不良,胫骨外侧平台多存在

【相似文献】