Clinical comparison of valgus and varus deformities in primary total knee arthroplasty following midvastus approach

The purpose of this retrospective study was to compare clinical parameters in preoperative, perioperative, and postoperative categories between valgus and varus deformities in primary total knee arthroplasty (TKA) following midvastus approach. We compared 83 patients (83 TKAs in valgus) with 949 patients (1084 TKAs in varus), with a mean follow-up of 72 months. In valgus deformity, mean age and body mass index at TKA were younger and smaller with more percentage of patellar subluxation. Cutting thickness from distal femur, tibial plateau, and lateral aspect of posterior femur were significantly different. The incidence of lateral release was 10.8% in valgus and 2.1% in varus. Although several significant differences were observed in preoperative and perioperative categories, the postoperative functional results were similarly evaluated by Knee Society knee and function scores.     

全膝关节置换治疗严重膝内翻伴屈曲畸形的疗效分析

目的：分析全膝关节置换（TKA）治疗严重膝内翻伴屈曲畸形的疗效。方法对2005年1月至2010年10月在本院行 TKA 治疗的25例（36膝）严重膝内翻伴屈曲挛缩畸形患者的临床资料进行回顾性分析,其中男7例,女18例,平均70．5岁（55～80岁）。原发疾病为骨性关节炎22例,类风湿性关节炎3例。术前术后均采用 HSS 膝关节评分系统评分,评价 TKA 的临床疗效。结果25例36膝均获得随访,平均术后随访6年（4～9年）。屈曲挛缩度由术前的（21±63）°减小到（1．1±2．3）°;内翻畸形由术前（35±4．8）°减小到（3±2．1）°;膝关节的活动度由术前（70．5±20．5）°增加到（115．1±5．3）°;膝评分平均为由（33．2±10．5）分提高到（90．7±8．5）分,功能评分平均为（35．5±14．2）分提高到（85．6±10．5）分,其中优21例（28膝）,良2例（3膝）,一般2例（3膝）;优良率为86％。多数病例术后膝关节力线正常,2例残留5°～10°的内翻畸形。结论全膝关节置换治疗严重膝内翻伴屈曲畸形能获得较好的临床效果。     

Autograft reconstructions for bone defects in primary total knee replacement in severe varus knees

Background:

Large posteromedial defects encountered in severe varus knees during primary total knee arthroplasty can be treated by cementoplasty, structural bone grafts or metallic wedges. The option is selected depending upon the size of the defect. We studied the outcome of autograft (structural and impaction bone grafting) reconstruction of medial tibial bone defects encountered during primary total knee replacement in severe varus knees.

Materials and Methods:

Out of 675 primary varus knees operated, bone defects in proximal tibia were encountered in 54 knees. Posteromedial defects involving 25-40% of the tibial condyle cut surface and measuring more than 5 mm in depth were grafted using a structural graft obtained from cut distal femur or proximal tibia in 48 knees. For larger, peripheral uncontained vertical defects in six cases, measuring >25 mm in depth and involving >40% cut surface of proximal tibial condyle, impaction bone grafting with a mesh support was used.

Results:

Bone grafts incorporated in 54 knees in 6 months. There was no graft collapse or stress fractures, loosening or nonunion. The average followup period was 7.8 years (range 5-10 years). We observed an average postoperative increase in the Knee Society Score from 40 to 90 points. There was improvement in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores in terms of pain, stiffness and physical function during activities of daily living.

Conclusion:

Bone grafting for defects in primary total knee is justified as it is biological, available then and is cost effective besides preserving bone stock for future revisions. Structural grafts should be used in defects >5 mm deep and involving 25-40% of the cut proximal tibial condyle surface. For larger peripheral vertical defects, impaction bone grafting contained in a mesh should be done.     

Less valgus alignment in total knee arthroplasty for the varus knee

Constitutional varus of the leg is well recognizable anatomically. Moreland[1] studied long standing radiographs of normal males with a range of varus from 2.6-3° in the proximal tibia. Victor et al. [2] reported constitution varus of 3 degree in 32% men, 17% women. The authors routine technique during total knee arthroplasty (TKA) is to cut the distal femur at 5° valgus and the tibia at neutral for the valgus leg and cut the distal femur at 5° valgus and the tibia 2° varus for varus aligned limbs. 127 consecutive long standing knee radiographs were not retrospectively studied pre and post operatively with 2 year minimum follow up. Average age was 68 years (range 51-90). Average weight was 215 lbs (range 110 – 333). Average tourniquet time was 32 minutes for all patients prior to closure.For the varus group (72 knees), average pre-op tibial femoral alignment was 3.3° varus (range 0-13°). Post-op tibial femoral alignment was 1.2° valgus (range 1° varus - 5° valgus) with the mechanical axis falling into the medial compartment in all patients. Average pre-op knee score was 88 and post-op was 180 at minimum of 2 years.For the valgus group (55 knees), average pre-op tibial femoral alignment was 7.5° (range 2°-24°) valgus. Average post-op tibial femoral alignment was 3.8° (range 1°-10°) valgus. Average pre-op knee score was 107 and post-op was 182 at minimum of 2 years. The authors agree with aiming for valgus alignment for the classic valgus leg (mechanical axis centered on hip, knee, ankle) and less valgus alignment for the varus knee (mechanical axis into the medial compartment). Following the patients anatomy eliminates the need for major soft tissue releases while still avoiding “malalignment”. No special soft tissue releases were required in any patient with pre-op varus or valgus alignment. The clinical outcome is not effected by leaving pre-op varus aligned extremities in less valgus with their TKA’s.     

合并膝内翻骨性关节炎全膝关节置换的处理

目的探讨膝骨性关节炎合并膝内翻畸形者行膝关节置换时膝内翻的矫正方法。方法172例（190膝）合并内翻畸形骨性关节炎患者进行全膝关节表面置换术。术前测量膝内翻角、关节面夹角、胫骨角、胫骨内翻角及胫骨平台后倾角,其内翻角为8°～21°,参考关节面夹角、胫骨角及胫骨内翻角确定膝内翻的类型,术中根据膝内翻的类型及构成因素进行相应的胫骨截骨及适度的软组织松解。结果出现切口感染2例（2膝）,1例为急性感染,1例为迟发性感染,2例均经清创、假体取出并膝关节融合术后痊愈。术后内翻矫正157膝,仍有膝内翻33膝,内翻角3°～9°（4.8°±0.9°）。165例（182膝）获得随访,时间8～90（40±3.5）个月。末次随访时除2例感染外,余膝关节活动度为：伸直0°168膝,伸直受限＆lt;10°11膝,伸直受限11°～15°3膝;屈曲90°～130°。临床及X线检查未见明显松动迹象。HSS膝关节评分由术前12～57（30±5.5）分提高到76～89（79.2±4.3）分。结论术前明确膝内翻的类型及构成因素,术中采取针对性操作进行适度的软组织松解及正确的截骨,是全膝关节置换膝内翻获得矫正的有效方法。     

人工全膝关节置换术在外翻膝的临床应用

[目的]探讨人工全膝关节置换术在外翻膝中的手术技术和临床疗效.[方法]2004年3月～2008年9月,对14例16个外翻膝行膝前正中、髌旁内侧入路,常规截骨、外侧软组织松解,后方稳定型假体或后交叉韧带保留型假体的人工全膝关节置换术进行回顾性研究.患者男3例,女11例,平均年龄60.5岁(45～77岁).经过随访比较手术前后膝关节屈伸活动度、KSS评分、膝关节X线情况来评估手术临床效果.[结果]术后平均随访42个月(24～54个月),膝关节屈伸活动度由术前平均82°(伸直0°～屈曲120°)提高到术后120°(伸直0°～屈曲150°);KSS评分:临床评分由术前平均43分(10～65分)提高到术后平均83.9分(70～100分),功能评分由术前平均52.9分(30～70分)提高到术后平均89.3分(75～100分);胫股角由术前平均16.5°(8°～30°)改善纠术后平均7°(5°～10°),膝外翻畸形得到良好的矫正.随访中无深静脉血栓、膝关节感染、髌骨半脱位或脱位并发症发生.[结论]膝前正中、髌旁内侧入路,常规截骨、外侧软组织松解,后方稳定型假体或后交叉韧带保留型假体的TKA治疗外翻膝临床疗效满意.     

Total knee arthroplasty in valgus knees using minimally invasive medial-subvastus approach

Background:

An ideal approach for valgus knees must provide adequate exposure with minimal complications due to approach per se. Median parapatellar approach is most commonly used approach in TKA including valgus knees. A medial subvastus approach is seldom used for valgus knees and has definite advantages of maintaining extensor mechanism integrity and minimal effect on patellar tracking. The present study was conducted to evaluate outcomes of total knee arthroplasty (TKA) and efficacy of subvastus approach in valgus knees in terms of early functional recovery, limb alignment and complications.

Materials and Methods:

We retrospectively reviewed 112 knees with valgus deformity between January 2006 and December 2011. All patients were assessed postoperatively for pain using Visual Analog Scale (VAS) and quadriceps recovery in form of time to active straight leg raising (SLR) and staircase competency and clinical outcomes using American Knee Society (AKS) score and radiographic evaluation with average followup of 40 months (range 24–84 months).

Results:

The mean VAS on postoperative day (POD) 1 and POD2 at rest was 2.73 and 2.39, respectively and after mobilization was 3.28 and 3.08, respectively (P < 0.001). The quadriceps recovery was very early and 92 (86.7%) patients were able to do active SLR by POD1 with mean time of 21.98 h while reciprocal gait and staircase competency was possible at 43.05 h. The AKS and function score showed significant improvement from preoperative mean score of 39 and 36 to 91 and 79 (P < 0.001), respectively, and the mean range of motion increased from 102° preoperatively to 119° at recent followup (P < 0.001). The mean tibiofemoral valgus was corrected from preoperative 16° (range 10°–35°) to 5° (range 3°–9°) valgus (P < 0.001).

Conclusions:

Mini-subvastus quadriceps approach provides adequate exposure and excellent early recovery for TKA in valgus knees, without increase in incidence of complications.     

(iii) Modern unicompartmental knee replacement

Unicompartmental knee replacement (UKR) or arthroplasty (UKA) has undergone a resurgence of interest and usage in recent years. This is partly due to the development of minimally invasive surgery (MIS) techniques for UKR. Many experienced arthroplasty surgeons correctly consider that UKR is more technically demanding than total knee replacement (TKR). However, in appropriately selected patients and with carefully performed surgery, the known benefits of UKR can be safely offered. Many previously learned lessons have had to be rediscovered to enable this technically demanding procedure. MIS has been demanded by patients and offered by surgeons but the limited surgical access makes the technical intricacy of UKR surgery even more demanding. Computer aided surgery (CAS) has emerged as a probable solution to this problem. This article examines the current place of UKR in arthroplasty surgery with particular reference to the new techniques of MIS and CAS. UKR has an important place in the selection of surgical options for the treatment of unicompartmental knee arthritis because of the rapid recovery, lower complication rate and high success rate compared to other available procedures.     

The biomechanical properties of the finger metacarpophalangeal joints to varus and valgus stress

PURPOSE: The purpose of this study was to determine the normal biomechanical properties of the passive capsuloligamentous structures about the finger metacarpophalangeal (MCP) joints subjected to dynamic varus/valgus loading and to equate these findings to the clinical situation. METHODS: The finger MCP joints from 9 fresh-frozen cadaver hands were tested in a custom-designed testing apparatus that applied a varus/valgus force in each direction. Testing was performed at 0 degrees, 30 degrees, 60 degrees, and 90 degrees of MCP joint flexion. Load-displacement curves were generated for each specimen. A nonlinear hysteresis curve was apparent on loading and unloading. A region of collateral ligament laxity was identified whereby minimal torque (< 0.5 Nm) caused progressive joint angulation. Subsequently incremental load was required to produce further joint angulation. The slope of this region was used to calculate early and late collateral ligament stiffness. RESULTS: The index and long fingers showed a significant decrease in the region of collateral ligament laxity between 0 degrees and 90 degrees. The long finger collateral ligament laxity also diminished significantly between 30 degrees and 90 degrees. The collateral ligament laxity did not significantly change in the ring and small digits throughout MCP joint flexion. The early or late phase of collateral ligament stiffness was not affected by the amount of MCP joint flexion across any of the digits, except in late radial collateral ligament stiffness of the long finger between 0 degrees and 60 degrees. CONCLUSIONS: The additional stability and clinical observation of tightening of the MCP in flexion appears related to the decreased laxity of the collateral ligaments and not to alterations in the biomechanical properties of the collateral ligaments.     

Computer-assisted navigation for cruciate-retaining total knee arthroplasty in patients with advanced valgus arthritic knees

BackgroundThe valgus arthritic knee is a complex deformity involving both soft tissue and bony problems that significantly affect the positioning of the components for, and decrease the accuracy of, reconstructed alignment in total knee arthroplasty (TKA). The unique bony deformity and soft tissue problem makes the use of conventional mechanical instrumentation difficult and leads to unsatisfactory results.PurposeThe purpose of this study was to investigate the effect of computer-assisted navigation for TKA on the postoperative mechanical axis, component alignment, and functional outcomes in the arthritic knee with genu valgus deformity.MethodsFrom January 2003 to August 2009, 24 patients (24 knees) with advanced valgus knee arthritis who underwent computer-assisted navigation for cruciate-retaining TKA were retrospectively reviewed. The accuracy of the postoperative mechanical axis and component alignment, and functional outcomes were assessed.ResultsThe mean postoperative mechanical axis was 180.2° (range, 178.1–182.5°). All patients achieved the targeted goal of a leg axis within 3° of the neutral axis. The joint line was not substantially elevated. No patient required conversion to a constrained component to achieve stability. At a mean follow-up of 45.5 months, the Hospital for Special Surgery (HSS) knee score improved from a mean preoperative score of 55.6 to 92.8 postoperatively. The International Knee Society (IKS) clinical score improved from 42.2 to 95.9. The IKS for pain improved from 15.4 to 47.1, and the IKS knee function score improved from 35.8 to 95.4.ConclusionComputer-assisted navigation for TKA is a useful alternative technique for advanced valgus knee arthritis where accurate restoration of the joint line, proper alignment of the limb and prosthetic components, and meticulous soft tissue balancing may be challenging because of bony deformities and soft tissue contractures.     

Clinical results in valgus total knee arthroplasty with the "pie crust" technique of lateral soft tissue releases

Numerous methods for creating symmetric flexion and extension gaps during knee arthroplasty in valgus knees have been proposed, and no consensus exists about the optimal technique. The "pie crust" technique for lateral soft tissue releases has been used extensively, yet few clinical results have been published. In this study, the clinical outcomes of 24 consecutive knees in 24 patients in whom this method was used in conjunction with a cemented posterior-stabilized prosthesis were evaluated. At a mean of 54 months' (range 24-69 months) follow-up, the knees were performing well with a mean Knee Society score of 97 (range 87-100) and mean range of motion of 121 degrees (range 100 degrees -145 degrees). Importantly, there were no clinical failures or cases of postoperative instability and no cases of radiographic loosening or wear.     

个性化截骨技术在严重膝内翻骨关节炎初次TKA中的应用价值分析

目的:探讨个性化截骨技术在严重膝内翻骨关节炎初次全膝关节置换术(total knee arthroplasty,TKA)中的应用价值和疗效分析。方法:自2018年6月至2020年1月收治36例(49膝)严重膝内翻骨关节炎患者,男15例(21膝),女21例(28膝);年龄59～82(67.6±6.5)岁;病程9.5～20.5 (15.0±4.5)年;骨关节炎Kellgren-Lawrence分级Ⅲ级11例(15膝),Ⅳ级25例(34膝);胫骨骨缺损分型AORI分型ⅠTa 8例(15膝),ⅡT2a型16例(18膝)。所有病例股-胫角(femor-tibial angle FTA)>15°,采用个性化截骨技术接受初次TKA,使用后稳定假体(posterior stability,PS)33例(45膝),PS假体胫骨侧联合使用金属垫块延长杆13例(15膝),踝限制性假体(legacy constrained condyarknee,LCCK)3例(4膝)。采用医院影像归档和通讯系统(picture archiving and communication systems,PACS)软件测量...     

The composite meniscal-capsular-fat pad flap in a lateral approach to the fixed valgus knee: an anatomical study

We present an anatomical study on the vascular supply to the patellar fat pad. Forty knees from fresh cadavers were dissected after injecting the femoral artery with colored latex. In all cases, the vascular supply to the fat pad depended essentially on the lateral inferior genicular artery, which enters this structure at its posterolateral extent. In the cases in which the fat pad flap was raised before the injection of latex, we observed good vascularization of the flap by the lateral genicular artery. This is a safe vascularized flap that offers an optimal covering of knee prostheses in fixed valgus knee deformities. An optimal procedure for raising the flap is proposed.     

高度膝关节外翻畸形人工膝关节置换术合并症的预防

目的 探讨预防高度膝关节外翻畸形人工膝关节置换术出现合并症的手术方法和技巧.方法 21例高度膝关节外翻畸形患者,应用膝关节髌骨外侧手术入路Z形切开,假体安放旋转定位,以膝关节周围韧带平衡后下肢力线为基准.膝关节外翻的软组织平衡方法:膝关节屈曲位和伸直位外侧间隙均紧张,在屈曲膝关节90°状态位,松解股骨外髁上外侧副韧带、关节囊后外侧角、腘肌腱;伸直位网格状松解髂胫束上方.屈曲位良好而伸直位紧张,松解髂胫束、外侧副韧带、后关节囊;屈曲位紧张伸直位良好,松解腘肌腱、外侧副韧带、关节囊后外侧角.结果 21例均获随访,时间9～28个月,2例迟发腓总神经麻痹,3个月后恢复.手术切口一期愈合.KSS评分术前为(43.3±4.1)分,术后12个月为(83.8±5.2)分,24个月为(87.4±4.5)分.结论 应用人工膝关节置换手术治疗高度外翻膝关节畸形,难于膝关节内翻,采用膝关节外侧手术入路和相应设计的手术方法,能够很好解决外翻膝关节人工关节置换手术出现的合并症.     

微创治疗拇外翻伴小趾内翻畸形的临床观察

目的:探讨小切口微创截骨矫形治疗拇外翻伴小趾内翻畸形的临床效果。方法:自2013年1月至2016年6月,采用微创小切口截骨矫形治疗168例拇外翻伴小趾内翻畸形患者,其中男7例,女161例;年龄22~75(59.3±3.5)岁。术前患者的主要临床症状为拇囊红肿、跖骨周围疼痛,拍摄患足正侧位X线片确诊为拇外翻及小趾内翻畸形。观察并比较手术时间、术后并发症情况,手术前后IMA(第1、2跖骨间角),HVA(拇外翻角),LDA(第5跖骨外翻角),MPA(小趾内翻角),IM4-5(第4、5跖骨间角)以及PASA(近端关节固定角)的变化,术后采用美国足踝外科协会拇趾-跖趾-趾间关节评分系统(AOFAS)进行功能评价。结果:168例患者获得随访,时间6~48(28.6±3.2)个月。术后伤口愈合良好,无感染、窦道形成等并发症发生。拇外翻矫形手术时间为16~28(18.3±2.1)min;小趾内翻矫形手术时间12~26(16.9±1.8)min;IMA、HVA、LDA、MPA以及IMA 4-5分别由术前的(10.1±2.1)°、(32.6±4.2)°、(6.9±2.3)°、(18.5±5.2)°、(15.1±2.9)°矫正到术后的(8.3±2.2)°、(10.9±2.9)°、(2.7±0.4)°、(6.5±1.6)°、(8.9±1.8)°,差异有统计学意义(P0.05)。而PASA由术前的(9.1±2.1)°矫正到术后的(8.7±1.9)°,差异无统计学意义(P0.05)。术后AOFAS功能评分由术前的31.6±3.9提高至术后的83.7±5.2,差异有统计学意义(P0.05);其中优147例,良13例,可6例,差2例。结论:微创治疗拇外翻伴小趾内翻畸形的临床效果良好,具有切口小、无缝线、外观美、手术时间短,术后功能恢复好的优点,值得在临床中推广。     

小切口单髁置换术治疗膝关节内侧间室骨关节炎94膝的中短期疗效研究

[目的]探讨小切口单髁置换术治疗膝关节内侧间室骨性关节炎的中短期疗效与手术技术。[方法]回顾性分析本院2003年1月～2010年6月收治的87例(94膝)经小切口单髁置换术治疗的膝关节内侧间室骨性关节炎患者的资料。对患者膝关节疼痛VAS评分、关节活动度、膝关节HSS评分、关节力线等进行评估分析,分析单髁关节置换临床效果、遇到的问题及应对方法。[结果]术后平均随访3.4年(6个月～7年),返修2例,无感染、深静脉血栓、假体脱位等,HSS评分由术前61.05分增至92.67分,优良率达92%。VAS评分由术前6.46分降至2.80分。术后疼痛缓解率94%。膝屈曲度平均达127.53°。术后力线平均内翻2°。[结论]小切口单髁置换术治疗膝关节内侧间室骨性关节炎中短期疗效满意,具有创伤小、恢复快、症状改善明显、术后功能良好等特点。     

Flexion-extension joint gap changes after lateral structure release for valgus deformity correction in total knee arthroplasty: a cadaveric study

At the time of total knee arthroplasty, the surgeon generally corrects excessive valgus knee alignment to anatomic valgus through release of lateral supporting structures. This study used a Cadaveric model to i) study the amount of correction achieved with each release step in 2 sequences of lateral release, ii) compare the amount of release in extension versus flexion, and iii) measure any associated rotational changes of the tibia. Six fresh-frozen Cadaveric knees were used to test the amount of change into varus after sectioning the iliotibial band (ITB), the popliteus tendon (Pop), the lateral collateral ligament (LCL), and the tendon of the lateral head of the gastrocnemius (LG). This sequence was then compared with a second sequence in another 6 cadavers as follows: LCL, Pop, ITB, and LG. The amount of valgus correction was tested in 90°, 45° flexion, and full extension. At each flexion angle, the corresponding releases were assessed with the tibia oriented vertically under its own weight, under tibial distraction with equal support from the lateral and medial soft tissues, and under a maximal varus deforming stress. Results showed that complete lateral structure release provides limited correction into a varus direction with a balanced distracted soft tissue gap or extension space (8.9° with the LG released), and the lateral aspect of the flexion gap opens more than the extension gap (8.9° compared with 18.1° in flexion). Early LCL release provided a more uniform release of the joint gap, and rotational changes were variable, tending toward external rotation of the tibia (6.0° in full extension with release of the LCL). We suggest that when severe valgus deformities are present, the LCL should be considered first for release and the Pop and ITB be used to grade the release.     

胫骨内侧高位楔形截骨治疗膝内翻畸形的临床疗效观察

[目的]探讨胫骨内侧高位楔形截骨治疗膝内翻畸形的疗效.[方法]1998年7月～2007年10月,采用胫骨内侧张开式高位楔形截骨结合植骨钢板内固定术治疗膝内翻畸形共49例72个膝关节.患者术前、术后8周、术后1.5年行患肢全长X线片检查,测量胫股角、胫股内侧关节间距大小.按HSS膝关节功能评定标准评定术前、术后膝关节功能.[结果]72膝术后随访18～128个月,平均58个月;胫股角术前187.5°±5.3°,术后172.6°±3.6°,膝关节功能由(47.2±17.6)分增至(83.2±15.3)分,胫股内侧关节间距由(2.4±1.2)mm增至(4.3±1.2)mm.植骨均愈合满意,无膝内翻复发.术后疼痛缓解及行走功能改善显著.术中出现关节内骨折3例,无神经血管损伤.术后皮肤感染切口延迟愈合2例.[结论]胫骨内侧高位楔形截骨结合植骨钢板内固定术,可作为治疗膝内翻畸形的有效方法之一.     

选择性软组织松解技术在重度膝外翻畸形全膝关节置换术中的应用

目的探讨全膝关节置换（TKA）术中对重度膝外翻畸形软组织平衡的处理方法。方法自2003-07—2009-12对29例（32膝）膝外翻畸形（胫股角〉15°）的患者均采用术中局部选择性松解技术实现软组织平衡。分别于术前和术后1、3、6、12、24个月摄膝关节正位X线片、测定膝关节活动度（ROM）和进行HSS评分,评估术后临床疗效。结果 21例（24膝）获得随访,随访时间9~47个月,平均27.2个月。X线片显示假体位置良好,未见明显松动和下沉迹象。术前关节活动度平均（103.5±8.7）°,末次随访时平均（123.3±6.3）°。术前HSS评分平均（62.5±8.6）分,末次随访时平均（86.9±4.6）分。术后均未出现严重并发症。结论局部选择性软组织松解技术在处理重度膝外翻畸形软组织失衡方面疗效确切,该技术损伤小、安全简便,是TKA术中矫正重度外翻畸形较理想的方法。     

膝关节外翻畸形的人工全膝关节置换术

目的探讨膝关节外翻畸形患者行人工全膝关节置换术(TKA)的手术方法和临床效果。方法对1996年1月至2004年8月74例87个膝关节外翻畸形TKA手术进行回顾分析。患者男11例,女63例,平均年龄63岁(26~80岁);股胫角(股骨和胫骨解剖轴线的夹角)平均为21·59°(12°~40°);应用后稳定型假体,采用髌旁内侧入路、常规截骨加单纯外侧软组织松解方法。随访检查膝关节活动度、X线外翻角度及KSS评分以评价手术效果。结果术后评价随访时间33·8个月(5个月~9年),根据膝关节活动度数及KSS评分评估关节功能情况。膝关节平均活动度为112·4°(80°~130°),KSS评分平均为81·7分(71~93分),比术前提高了59分;功能评分平均为86·3分,比术前提高了59·8分。所有膝关节在行TKA后外翻畸形基本得到矫正,随访时外翻度数(股胫角)平均为8·7°(0°~11°),较术前有明显改善。随访时1例患者有膝关节轻度不稳症状,1例术前严重髌脱位患者术后髌骨存在半脱位,其余正常。结论对于膝关节外翻畸形患者,采用髌旁内侧入路、常规截骨加单纯外侧软组织松解以及安装后稳定型假体的方法,可取得比较满意的临床效果。