后稳定型全膝关节置换术治疗成人膝大骨节病混合畸形

背景：成人膝大骨节病（Kashin-Beck disease,KBD）混合畸形采用常规方法治疗很难奏效,常需关节置换手术治疗。应用后稳定型全膝关节置换术（total knee arthroplasty,TKA）治疗成人膝KBD混合畸形的治疗方法及疗效有待探讨。目的：探讨后稳定型TKA治疗成人膝KBD混合畸形的手术方法及临床疗效。方法：应用TKA治疗成人膝KBD混合畸形23例（27膝）,男14例（17膝）,女9例（10膝）;年龄54～79岁,平均63.2岁;病程3.8～27年,平均13.5年。膝内翻畸形5°～20°,平均11.5°;膝外翻畸形10°～35°,平均18.5°;术前屈曲挛缩畸形5°～40°,平均12.4°。应用膝关节HSS评分标准及畸形矫治角度进行效果评价,膝关节HSS评分术前33.4～75.6分,平均43.5分,良3膝（11.1%）,可15膝（55.6%）,差9膝（33.3%）。混合畸形包括内翻内旋、外翻外旋和屈曲挛缩畸形。结果：随访时间为2个月～6年,平均28个月。1例下肢血栓性静脉炎经保守治疗痊愈;1例术后6个月时髌前痛,行股四头肌功能锻炼疼痛消失。随访期间无一例出现假体周围透明带、假体下沉或松动、植骨块移位、骨折、骨吸收、骨不愈合及胫骨平台塌陷。终末随访HSS评分为63.7～89.4分,平均82.6分,优18膝（66.67%）,良7膝（25.93%）,可2膝（7.40%）。各种混合畸形角度得到很大程度矫治。结论：应用后稳定型TKA治疗成人膝KBD混合畸形,可有效矫治内外翻、屈曲、旋转畸形,缓解疼痛,恢复膝关节功能,近期疗效满意。

Stabilized prosthesis after total knee arthroplasty for the adult Kaschin-Beck disease with mixed deformities

Background:Conventional therapy is difficult to treat adult Kaschin-Beck disease(KBD) with mixed deformities unless total knee arthroplasty(TKA).Therefore,it is worth to explore the surgical treatment and its clinical effect.Objective:To explore the operative treatment and clinical effect of stabilized prosthesis after TKA for the adult KBD with mixed deformities.Methods:Totally 23 KBD patients with mixed deformities(27 knees) underwent stabilized prosthesis after TKA.There were 14 males(17 knees) and 9 females(10 knees) with an average age of 63.2 years(range 54-79 years).The average course of disease was 13.5 years(range 3.8 to 27 years).The average genu varum was 11.5°(5°-20°),the average genu valgum was 18.5°(10°-35°) and the average flexion contracture was 12.4°(5°-40°) preoperatively.The Hospital for Special Surgery(HSS) knee-rating score and corrected angle of deformity were used for the functional assessment of the treatment.The average HSS score was 43.5(33.4-75.6) preoperatively,and the functional assessment was good in 3 knees(11.1%),fair in 15 knees(55.6%) and poor in 9 knees(33.3%).Results:The average duration of follow up was 28 months(range 2 months to 6 years).Thrombophlebitis of lower extremity in one patient was cured by conservative treatment.One case complicated by patellar pain 6 months after the surgery and was cured by the functional exercise of the femoral quadriceps.No complications,such as periprosthetic osteolysis,dislocation,fracture,bone resorption or nonunion and tibial plateau collapse happened.The average HSS score was 82.6(63.7-89.4) at the last follow up.The clinical outcomes were excellent in 18 knees(66.67%),good in 7 knees(25.93%) and fair in 2 knees(7.40%).Conclusions:Stabilized prosthesis after total knee arthroplasty can effectively correct genu varum,genu valgum and flexion contracture,alleviate the pain,resonstruct the joint function of knees for the adult Kaschin-Beck disease with mixed deformities.