股骨侧弓畸形对全膝关节置换术预后的影响

目的 探讨冠状位股骨侧弓畸形的存在对全膝关节置换术（total knee arthroplasty，TKA）疗效的影响。方法 回顾性分析西安交通大学附属红会医院膝关节外科2015年1月至2017年12月接受TKA手术病人142例，其中男28例，女114例；年龄为（67.3±6.7）岁（52~82岁）。根据标准负重正位X线片测量病人股骨侧弓角（femoral bowing angle，FBA）。将FBA＜177°定义为股骨侧弓畸形，根据是否存在股骨侧弓畸形将病人分别纳入股骨侧弓畸形组和直股骨组。使用美国膝关节协会评分（Knee Society score，KSS）及西安大略和麦克马斯特大学（Western Ontario and McMaster University，WOMAC）骨关节炎指数评估病人功能状态。结果 142例病人平均随访49.4个月（43~55个月）。股骨侧弓畸形组59例，直股骨组83例，且股骨侧弓畸形组女性病人比例明显高于直股骨组，差异有统计学意义（P＜0.05）。所有病人在末次随访时的KSS评分、WOMAC评分及分量表均较术前得到明显的改善（P＜0.05）。进一步分析发现，末次随访时直股骨组与股骨侧弓畸形组病人的KSS膝总分［（78.1±6.2）分 vs. （75.1±7.8）分］、疼痛评分［（48.2±2.4）分 vs. （47.0±4.0）分］、WOMAC B部分（僵硬部分）得分［（0.4±0.7）分 vs. （0.7±1.1）分］相比，差异均有统计学意义（P＜0.05）。结论 股骨侧弓畸形多发生于女性；存在股骨侧弓畸形的骨关节炎病人行TKA术后近中期临床效果不及直股骨病人。

Effect of Femoral Lateral Bowing on Prognosis of Total Knee Arthroplasty

Objective To explore the effect of patients with femoral lateral bowing on efficacy after total knee arthroplasty (TKA). Methods The clinical data of 142 patients given TKA in Knee Surgery Department of Xi''an Jiaotong University Affiliated Honghui Hospital from January 2015 to December 2017 were retrospectively analyzed. There were 28 males and 114 females with age (67.3±6.7) years old (52-82 years old). The femoral bowing angle (FBA) of the patient was measured based on standard weight-bearing X-ray. FBA＜177° is defined as femoral lateral bowing, and patients were divided into the femoral lateral bowing group and the straight femur group based on the presence of femoral bowing. Knee Society Score (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used to evaluate the function. Results All 142 patients were followed up for an average of 49.4 months (43-55 months). There were 59 cases in the femoral lateral bowing group and 83 cases in the straight femur group, and the proportion of female patients in the femoral lateral bowing group was significantly higher than that in the straight femur group (P＜0.05). The KSS score and WOMAC score of all patients at the last follow-up showed significant improvement compared to those before surgery (P＜0.05). Further analysis found that KSS knee society score (78.1±6.2 vs. 75.1±7.8), KSS pain score (48.2±2.4 vs. 47.0±4.0), and WOMAC part B score (0.4±0.7 vs. 0.7±1.1) in straight femur group were significantly different from those in femoral lateral bowing group (P＜0.05). Conclusion Female patients lean to existing femoral lateral bowing. The presence of femoral bowing affects the outcome after TKA. The patients with straight femoral leads to better clinical outcomes after TKA than patients with femoral lateral bowing at a short- and medium-term follow-up.