个体化的软组织平衡技术在膝外翻全膝关节置换术中的应用

目的探讨在膝外翻畸形全膝关节置换(TKA)术中应用个体化软组织平衡技术的临床效果及手术方法。方法膝外翻患者,术前X线测量股骨和胫骨解剖轴线夹角(FTA角),根据膝外翻畸形Keblish分级(轻度<15°;中度15°～30°;重度>30°),分为轻、中、重三级并认真评估患者软组织状况。软组织平衡术分为三步,第一步切开关节囊前行髂胫束苹果派样延长,第二步自胫骨结节骨膜下松解骼胫束止点和外侧副韧带,第三步自股骨侧松解外侧副韧带及后外侧关节囊。手术方法采用髌旁外侧入路,不同分级个体化的应用上述3步软组织平衡方法行TKA手术。术后测量FTA角,术后定期随访行美国膝关节协会评价标准KSS评分及功能评分与术前比较,评价手术效果。结果 2008年1月～2011年12月,20例(23膝)膝外翻患者,Keblish分级轻度8例8膝,中度7例10膝,重度5例5膝;轻、中、重三级患者应用个体化的软组织平衡方法实施TKA手术;所有患者均获得随访,随访时间6～48个月。术前术后FTA角及KSS评分、功能评分结果经SPSS14.0统计学软件做配对样本t检验,差异均有统计学意义(P<0.01)。全部患者术后外翻畸形均得到完全矫正,关节稳定性良好。结论膝外翻畸形TKA术中选择个体化的软组织平衡方案,可以有效地矫正软组织失衡而获得满意的临床效果,同时又可以避免矫枉过正导致术后关节不稳。

Personalized soft tissue balance technique in total knee arthroplasty for volgus knee

Objective To investigate the clinical efficacy and surgical methods of the total knee arthroplasty （TKA） using personalized soft tissue balance technique for volgus knee. Methods The tibial and femur angle （FTA） was measured before TKA operation. According to Keblish grade （mild 〈 15°; moderate 15° to 30° ; severe 〉 30°） , the patients with volgus knee were divided into mild, moderate, and severe grades. The soft tissue balance technique included three steps： first, before the joint capsule was cut open, ilio-tibial band was performed apple-pie like elongation; second, I-T band and lateral collateral ligament were released at Gerdy tubercle; third, lateral collateral ligament and poster-lateral capsule were released from the femural side. TKA was performed by lateral parapatellar approach, and personalized soft tissue balance was applied according to different grades. The average function score, Knee Society Score System （KSS） and the FTA angle were measured at follow-up and were compared with pre- operative results. Results Between January 2008 and December 2011, 20 cases （23 knee）were enrolled, among which eight patients （eight knees ） were mild grade and seven patients （10 knees） were moderate grade and five patients （five knees） were severe grade. All patients were followed up for 6 to 48 months. There were statistically significant differences （P 〈 0. 01 ） in post-operative average function score, KSS and FI＇A, comparing with the pre-operative ones. After operation, the valgus deformity of all patients was corrected and the stability of knee was good. Conclusions The personalized soft tissue balance technique in total knee arthroplasty can correct valgus deformity successfully and avoid the joint instability caused by over correction.