髌旁外侧人路进行外翻膝人工全膝关节置换术的探讨

目的 探讨应用外侧入路进行外翻膝全膝关节置换术的疗效.方法 2008年12月至2011年3月,对10例(12膝)外翻膝畸形患者施行了全膝关节置换术.女3例,男3例,平均年龄71.4岁(61~77岁).所有患者均采用膝关节外侧人路,将外侧支持带进行冠状面"Z"字成形,分步骤按照拉花技术进行髂胫束止点、后外侧关节囊、外侧副韧带等松解以获得屈、伸间隙的软组织平衡,假体就位后错位缝合外侧支持带的浅、深层.术后3、6、12个月及之后每年门诊随访,应用HSS评分对膝关节功能进行评价.结果 所有病例均应用后稳定型假体(G2,施乐辉公司,美国),全部患者的外翻畸形均获得矫正,下肢力线由术前平均外翻18.4°(15°~24°)恢复至平均外翻6.8°(4°~9°).所有病例获得随访,平均12.4个月(3~24个月).至最后随访时,HSS评分由术前的平均42.4分(35~58分)恢复到平均86.4分(76~95分).结论 膝关节外侧入路能很好地显露外翻膝的外侧挛缩结构,有利于对挛缩结构进行准确的松解,外侧支持带的"z"字成型方法有效地解决了髌骨的松解和假体软组织覆盖的矛盾,是中、重度外翻膝进行膝关节置换的良好入路.

Lateral parapatellar approach for total knee arthroplasty of valgus knee

Objective To evaluate the clinical outcomes of lateral parapatellar approach in total knee arthroplasty（TKA）of valgus knee.Methods From December 2008 to March 2011,toatal knee arthroplasties were performed for 10 patients（12 knees）with valgus knee deformity.There were 7 female and 3 male with an average age of 71.4 years old（range from 61 to 77 years old）.After incision of the skin through lateral approach,ilio-tibial band,posterior capsule and lateral collateral ligment was prolonged by pie-crusting technique.Coronal ＂Z＂plasty was used in lateral retinaculum release.During the follow-up period at 3,6,12 months postoperatively and then annually thereafter,HSS score（Hospital for special surgery）was used for clinical evaluation.Results All the patients were followed up for a mean time of 12.4 months（range from 3 to 24 months）.Cemented PS prosthesis（Smith-Nephew,USA）were used in all cases.The valgus deformities were successfully corrected from average 18.4°（range from 15° to 24°）valgus preoperatively to average 6.8°（range from 4° to 9°）postoperatively.At the latest follow-up,HSS score was improved from preoperative 42.4 points（range from 35 to 58 points）to postoperative 86.4 points（range from 76 to 95 points）.Conclusions It is satisfying to treat moderate to severe valgus knee deformity with lateral approach during TKA.Lateral rantinaculum ＂Z＂plasty successfully solve the problem between lateral release and soft tissue coverage during valgus TKA.