一期全膝关节置换术治疗膝关节骨关节炎合并关节外畸形

 目的 探讨膝关节骨关节炎合并关节外畸形患者一期行全膝关节置换术(total knee arthroplasty,TKA)的可行性及其疗效。方法 2006年6月至2010年4月对9例骨关节炎合并关节外畸形患者行一期TKA.男 2例, 女7例;年龄 34~69岁,平均 51岁。股骨侧畸形5例.胫骨侧畸形4例;除 1例畸形由发育不良引起外.其余 8例均由骨折畸形愈合造成。结果 术后随访时间 7~54个月,平均 29个月。 HSS评分从术前平均 18.7分(6~39分).提高到术后平均 89.8分(81~96分)。膝关节活动度由术前平均 46.7°(0°~100°).提高到术后平均 100.6°(85°~115°)。下肢力线由术前平均偏移 11.8°(2°~21°)减少到术后平均偏移 1°(0°~4°);未发现假体松动征象。除 1例患者随访发现截骨处延迟愈合外.其余患者均无感染、下肢深静脉血栓、膝关节不稳及髌骨问题等并发症。结论虽然伴有关节外畸形的膝关节骨关节炎患者一期行 TKA手术难度较大.但通过制定合理的手术方案可以取得与普通 TKA相似的手术效果。如果可行.推荐采用关节内代偿性截骨加软组织平衡术矫正畸形。

Total knee arthroplasty for osteoarthritis of the knee with extra-articular deformity

Objective To evaluate the feasibility and clinical results of one-stage total knee arthroplasty in patients with extra-articular deformity and osteoarthritis of the knee. Methods From June 2006 to April 2010, 9 patients with osteoarthritis of the knee and extra-articular deformity underwent one-stage total knee arthroplasty, including 2 males and 7 females with an average age of 51 years (range, 34-69). These deformities were in the tibia in 4 patients and in the femur in 5. The deformity resulted from fracture malunion in 8 cases and dysplasia in one. There were 6 uniplanar and 3 biplanar deformities. The average angle of the femoral deformities was 13.3° in the coronal plane (ranged from 8° to 22°) and 11.3° in the sagittal plane (ranged from 6° to 15°). One femur had a 10° deformity of external rotation. The average angle of the tibial deformities was 16° in the coronal (ranged from 11° to 22°), One was 21° in the sagittal plane. Results The mean follow-up period was 29 months (range, 7-54) after surgery. The average HSS score improved from 18.7 points preoperatively to 89.8 points at the time of the last follow-up. The average arc of knee motion improved from 46.7° preoperatively to 100.6° postoperatively. The average deviation of mechanical axis of knee was improved from 11.8° of excursion preoperatively to 1° of excursion at the time of the last follow-up. One patient had an unsatisfactory clinical result from delayed union at the esteotomy site. No complications such as infection, DVT, ligament instability, patella problem or component loosening. Conclusion One-stage total knee arthroplasty is a technically difiicult but effective treatment for patients with osteoarthritis of the knee and extra-articular deformity. We recommend that if feasible total knee arthroplasty with intra-articular bone resection and soft-tissue balancing for these patients.