膝关节骨性关节病并内翻畸形的外科治疗—介绍一种新手术方法

自1986年5月～1988年7月,作者采用改良的 Koshino 手术方法,治疗膝关节骨性关节病并内翻畸形21例(22个膝)。本文介绍了其手术方法、手术指征及术后处理。作者认为:该手术方法设计合理、矫形确切、内固定牢靠、并发症少,可供治疗膝关节骨性关节病并内翻畸形时选择。     

膝内翻伴胫骨旋转的治疗

目的 观察胫骨高位截骨，胫骨结节旋转抬高治疗膝内翻伴胫骨旋转畸形的效果。方法 通过膝关节生物力学研究。简化了胫骨高位截骨的测量方法，在胫骨高位截骨的同时进行胫骨结节旋转抬高，恢复胫股关节，髌股关节的生理功能。结果 随访1-8年，通过X线，CT检查及膝关节功能评定，其优良率为88%。结论 胫骨高位截骨，胫骨结节旋转抬高治疗膝关节内侧间隔退行性关节炎，胫骨旋转所致髌股关节炎，符合生物力学要求，长期随访效果满意。     

Spontaneous Correction of Severe Tibiofemoral Deformity in Growing Children

The progress of pronounced varus and valgus deformities of the knees in 20 children were followed. The most pronounced varus deformity was 33 degrees and the most pronounced valgus deformity was 20 degrees. The tibiofemoral angle in growing children was measured on roentgenograms by drawing a longitudinal axis between the femoral and tibial diaphyseal cortices. Spontaneous correction was seen in all cases during the growth period.     

Coronal plane deformity around the knee in the skeletally immature population: A review of principles of evaluation and treatment

Coronal plane deformity around the knee, also known as genu varum or genu valgum, is a common finding in clinical practice for pediatricians and orthopedists. These deformities can be physiological or pathological. If untreated, pathological deformities can lead to abnormal joint loading and a consequent risk of premature osteoarthritis. The aim of this review is to provide a framework for the diagnosis and management of genu varum and genu valgum in skeletally immature patients.     

Aggravation of Ankle Varus Incongruency Following Total Knee Replacement Correcting ≥10° of Genu Varum Deformity: A Radiographic Assessment

BackgroundThis study aimed to investigate the change in ankle varus incongruencies following total knee replacement (TKR) in patients with preoperative genu varum deformity of ≥10°.MethodsThe study cohort was composed of patients who underwent TKR in a single institution for knee osteoarthritis with preoperative genu varum deformity of ≥10° and concomitant varus ankle incongruencies. Eight radiographic measurements were evaluated preoperatively and postoperatively: mechanical tibiofemoral angle, mechanical lateral distal femoral angle, medial proximal tibial angle, lateral distal tibial angle, tibial plafond inclination, talar inclination, tibiotalar tilt angle (TTTA), and tibia-mechanical axis angle. Of these, TTTA represented the quantitative degree of ankle joint incongruency.ResultsA total of 110 patients (male = 2; female = 108) were included in the analysis. The mean patient age was 68.9 (standard deviation [SD] 7.2) years at the time of TKR. All radiographic measurements showed significant changes postoperatively, representing the appropriate correction of genu varum deformity and restoration of the mechanical axis. Nineteen patients (17.3%) showed postoperative decrease in TTTA, 2 (1.8%) remained the same, and 89 (80.9%) showed increase. Overall, mean preoperative and postoperative TTTA were 3.3° (SD 2.2°) and 4.7° (SD 2.9°), respectively (P < .001), representing the aggravation of varus ankle incongruencies.ConclusionVarus ankle incongruencies showed aggravation following TKR despite correction of genu varum deformity and restoration of the mechanical axis. This could be an important cause of postoperative increase or development of ankle pain following TKR. Therefore, patients with preoperative varus ankle incongruencies need to be warned of possible aggravation of ankle symptoms and be evaluated before TKR.Level of EvidencePrognostic level III.     

早期加强膝关节稳定训练对脑卒中患者膝过伸的影响

目的:探讨脑卒中患者早期加强膝关节稳定性训练的作用.方法:58例脑卒中患者分为A组30例和B组28例,均给予必要的药物及常规康复治疗,A组患者在发病早期即配合膝关节稳定性训练.结果:治疗3个月后,A组发生膝过伸患者9例,B组17例(30%、60.7%,P＜0.05);2组Holden功能性行走能力与治疗前比较有很大提高(P＜0.01),2组间比较,A组提高更显著(P＜0.01).结论:早期加强脑卒中患者的膝关节稳定性训练可以减少膝过伸的发生,提高行走能力.     

Computed Tomography Evaluation in Total Knee Arthroplasty: Computer-Assisted Navigation Versus Conventional Instrumentation in Patients With Advanced Valgus Arthritic Knees

Arthritic knees with advanced valgus deformity present with soft tissue and osseous anomalies that make total knee arthroplasty (TKA) difficult. We conducted a retrospective chart review of 41 patients (51 knees) to determine whether computer-assisted surgery-TKA (CAS-TKA) is superior to TKA using conventional guiding systems. A significantly higher rate of lateral retinaculum release as well as outlier of sagittal mechanical axes and position of the femoral component (femoral flexion and femoral rotational angle) was recorded in the conventional TKA group versus the CAS-TKA group. Both groups had significant postoperative improvement in clinical performance, but results did not differ significantly between groups. Despite its radiographic benefit, CAS-TKA showed no significant benefit over TKA in short-term clinical functional outcomes when performed by an experienced surgeon.     

3D-FS-SPGR序列在膝关节软骨病变的临床应用研究

目的　利用3D-FS-SPGR序列测量各期膝关节OA软骨厚度,探讨OA膝关节软骨厚度与病变进展的关系。 方法　62例OA患者行膝关节MRI检查,用3D-FS-SPGR序列测量不同部位关节软骨的厚度,并与20名对照组膝关节MRI检查结果进行比较。 结果　轻度OA组关节软骨厚度与正常组之间无统计学差异（P＞0.05）,而重度OA组大部分软骨区域软骨厚度与正常组有统计学差异（P＜0.05）。软骨厚度的改变可能受到多方面因素的影响,年龄、体重及BMI等与软骨厚度改变之间存在负相关。 结论　关节软骨负重面大部分区域随着OA病情的加重,其软骨厚度变薄,软骨厚度改变可能还受到体重、年龄及性别等因素的影响。     

胫骨高位嵌插截骨锁定钢板固定治疗老年膝内翻型骨性关节炎

2003年7月-2008年12月,我科采用胫骨高位嵌插截骨锁定钢板固定治疗48例膝内翻型骨性关节炎患者,疗效满意。 1材料与方法1.1病例资料本组48例54膝,男19例21膝,女29例33膝,年龄60-75（66.8±3.4）岁。病程3-15（8.5±2.5）年。     

股骨远端内翻截骨加交锁髓内钉固定治疗膝外翻畸形

目的　探讨股骨远端内翻截骨加交锁髓内钉固定 ,治疗伴有膝外翻畸形的膝关节骨性关节炎的疗效。方法　 1996年 5月～ 2 0 0 0年 8月 ,采用股骨远端内翻截骨加交锁髓内钉固定治疗 16例 (16膝 )伴膝外翻畸形的膝关节骨性关节炎 ,病程 1～ 2 1年 ,平均 5 .2年。按 Ahlback分类 度 10例 , 度 6例。股骨髁上截骨 11例 ,股骨干远端截骨 5例。术前、术后 8周和 2年均行患肢全长 X线片检查 ,以测量股胫角、胫骨角、股骨角及胫股关节面切线夹角及胫股外侧间距大小。按膝关节功能评定标准 ,评定术后膝关节功能恢复情况。　结果　 16例术后获随访 2 5～ 4 6个月 ,平均 31个月。术后 2年随访骨愈合满意 ,1例延迟愈合 ,为股骨干远端截骨患者。皮肤感染 1例。膝关节功能自 5 0 .4± 15 .9分增至 78.5± 12 .9分 ,胫股关节面切线夹角自 5 .6± 2 .9°减少至 1.6± 3.4°,胫股外侧关节间距自 2 .1± 1.8mm增至 4 .7±1.7m m。　结论　股骨远端内翻截骨加交锁髓内钉内固定 ,可作为治疗伴有膝外翻畸形的膝关节骨性关节炎的有效方法之一。