残留内翻对弓形股骨患者全膝关节置换术后功能恢复的影响

目的探究残留内翻的下肢力线对弓形股骨患者行全膝关节置换术(total knee arthroplasty,TKA)术后功能恢复的影响。方法本研究回顾性收集西安市红会医院膝关节外科2015年1月至2015年12月,接受同一术者实施TKA的59例(71膝)骨关节炎患者的全部资料,其中男6例(8膝),女53例(63膝);年龄58~82岁,平均(67.7±5.7)岁。测量患者股骨侧弓角(femoral bowing angle,FBA)及下肢力线(hip-knee-ankle angle,HKA)。FBA<177°定义为弓形股骨。根据术后负重位标准正位X线片将患者分为两组:残留内翻组32例37膝(HKA<177°),中立位力线组27例34膝HKA为(180±3)°]。以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骨关节炎指数评分(the western Ontario and McMaster universities osteoarthritis index,WOMAC)评价两组术后功能及症状。结果患者均获随访,随访时间43~55个月,平均随访时间为(49.30±4.11)个月。全部患者均未见假体松动、感染等严重并发症。两组患者术前KSS及WOMAC评分比较,差异无统计学意义(P<0.05);手术前后比较差异有统计学意义(P>0.05);术后残留内翻组WOMAC总分(5.57±6.23)分]较中立位力线组(9.27±8.86)分]明显降低,WOMAC C部分(日常生活困难程度)评分(4.95±5.87)分]显著低于中立位力线组(8.24±7.68)分],余各评分比较差异无统计学意义(P<0.05)。结论相比中立位力线,存在弓形股骨的患者行TKA术后下肢力线残留内翻可以获得更好的临床结局,但中远期疗效有待进一步观察。

Effect of Remaining Mild Varus on Clinical Outcome after Total Knee Arthroplasty in Patients with Lateral Femoral Bowing

Objective To explore the effect of remaining mild varus on postoperative functional recovery after total knee arthroplasty(TKA)in patients with femoral bowing.Methods A retrospective review of aprospectively maintained data base were performed.We retrospectively analyzed 59 patients(71 knees)of undergoing TKA by the same surgeon,including 6 cases(8 knees)of males and 53 cases(63 knees)of females,from January of 2015 to December of 2015.Mean age of patients was(67.7±5.7)(range 58~82).Femoral bowing Angle and hip-knee-ankle Anglewere measured.FBA<177°was defined as the femoral bowing.Patients were divided into two groups according to the postoperative HKA angle from weight-bearing full-leg radiographs:varus malalignment group with 32 patients(37 knees),HKA<177°;neutral alignment groupwith 27 patients(34 knees),HKA was(180±3)°.The Knee Society Score(KSS)and the Western Ontario and McMaster Universities Arthritis Index(WOMAC)were compared between preoperative and postoperative.Results Mean of follow-up was(49.30±4.11)months(range,43~55 months).No revisions occurred in any of the groups at midtermfollow-up.There were no statistical difference in preoperative KSS and WOMAC scores.All patients improved between preoperative and post-operative timepoints(P<0.05).The WOMAC total score of varus malalignment group(5.57±6.23)were significantly lower than that in the neutral alignment group(9.27±8.86);the WOMACpart C score of varus malalignment group(4.95±5.87)were significantly lower than that in the neutral alignment group(8.24±7.68).There was no significant difference in the remaining scores(P<0.05).Conclusion For patients with lateral femoral bowing,residual varus alignment leads to better clinical outcomes after TKA than neutral alignment at a mean follow-up of 49.3 months.However,The effect of residual varus alignment on the survivalship of the prosthesis and the long-term outcome needs to be further evaluated.