膝关节侧方移位失稳的膝关节置换

目的探讨膝关节侧方移位失稳患者行全膝关节置换(TKA)方法和疗效。 方法回顾性分析解放军兰州总医院全军骨科中心关节外科2010年1月至2017年6月期间，收治17例(20膝)成人膝关节骨关节炎或类风湿关节炎合并膝关节侧方移位失稳患者，进行人工膝关节置换的临床疗效。其中男6例(8膝)，女11例(12膝)。纳入标准：晚期膝关节骨关节炎或类风湿性关节炎，合并膝关节水平移位不稳进行初次TKA手术患者，获完整随访者。排除标准：单纯膝关节内、外翻畸形患者，膝关节有反屈不稳者。本组骨关节炎9例(10膝)，类风湿性关节炎8例(10膝)。17例(20膝)均表现为股骨远端关节面相对胫骨平台关节面向内侧水平移位，侧方移位距离平均(12.0±2.3 )mm，其中5例(5膝)侧位X线片上还呈现股骨远端关节面向胫骨平台后方移位。采用美国膝关节协会评分(KSS)及膝关节活动度(ROM)对术前及末次随访时膝关节功能进行评估。数据采用SPSS 18.0统计软件进行统计学分析，术前、术后数据均值比较采用配对样本t检验。 结果所有患者均获随访，随访时间平均(31.5±0.3)个月。KSS临床评分从术前平均(33±12)分提高至末次随访时平均(89±7)分，KSS功能评分从术前平均(36±9)提高至末次随访时平均(86±6)分。膝关节活动度由术前平均(69±29)°提高至末次随访时平均(103±13)°。本组病例无深部感染、血栓形成、膝关节不稳、假体松动及脱位等并发症发生。 结论侧方移位失稳的膝关节行初次行人工全膝关节置换手术时应对膝关节侧副韧带结构与功能状况进行准确评估；有针对性的软组织平衡技术以及正确选择假体限制级别是手术成功的关键。

Total knee arthroplasty in treatment of knees with severe lateral instability

ObjectiveTo investigate the method and clinical effect of primary total knee arthroplasty(TKA) for the patients with severe later unstable knee. MethodsA respective analysis was carried out. From January 2010 to June 2017, 17 patients (20 knees) with severe lateral instability underwent primary TKA in the joint department of the Lanzhou General Hospital of PLA. Among them, eight knees were from six males and 12 knees were from 11 females. Inclusion criteria: late stage of osteoarthritis or rheumatoid arthritis with medial-lateral instability of knee who underwent primary TKA. Exclusion cariteria: varus or valgus deformity of knee, extension subluxation of knee. In this group, osteoarthritis were nine cases (11 knees) and rheumatoid arthritis were eight cases (11 knees). The preoperative medial-lateral instability in the coronal plane was (12.0± 2.3) mm on anterior-posterior views. The functions of knee joint before and after the operation were evaluated with the American Knee Society score (KSS) and the range of motion (ROM). SPSS 18.0 statistic software was used to analyze the data, comparing the preoperative and postoperative data by paired t test. ResultsAll the patients were followed up for (31.5±0.3) months on average. KSS clinical score improved from preoperative (33±12)to( 89±7), and the KSS functional score improved from preoperative (36±9) to (86±6) at the final follow-up. The range of motion of the knee was improved from (69±29)° to (103±13)°. There was no complication such as infection, deep vein thrombosis, knee inst-ability or component loosening. ConclusionTKA for the knees with lateral instability demands precise evaluation for the structure and function of the ligaments of knee; good balance of soft tissues and correct prothesis selection of is the key to operation.