多针穿刺松解内侧副韧带在中度膝内翻畸形全膝关节置换术中的应用

目的 分析多针穿刺延长法松解内侧副韧带（MCL）对中度膝关节内翻畸形全膝关节置换术（TKA）中软组织平衡的有效性和安全性。方法 回顾性分析2013年1—6月上海交通大学附属第六医院骨科，TKA术中采用多针穿刺技术松解MCL以获得软组织平衡的中度内翻型膝关节骨性关节炎55例患者资料，其中男19例、女36例，年龄57～79岁。术后康复按照我科标准膝关节康复计划进行。术后3周复查拍摄下肢站立位全长片，术后3个月、6个月、1年拍摄患膝关节站立位正侧位片，并检查膝关节活动度，进行美国膝关节协会评分（KSS）临床评分和功能评分，做内外翻应力测试检查膝关节稳定性。平均随访时间14个月，采用配对t检验分析术前及术后膝关节力线、膝关节屈曲活动度、KSS临床评分及功能评分的差异。结果 根据术中松弛度测量标准，55例病例术中均获得了满意的内外侧软组织平衡，未出现内侧过度松弛的情况。术后利用膝关节站立位全长片测量膝关节力线显示，由术前的内翻13．5°±3．36°（9°-25°）纠正至术后的内翻0．8°±1．07°（内翻3．5°-外翻2．0°）；KSS临床评分从术前（39．9±7．84）分（20—65分）改善至末次随访的（94．0±7．27）分（65～100分），KSS功能评分从术前（35．2±10．51）分（20～80分）改善至末次随访的（85．0±10．84）分（50～100分）；膝关节屈曲活动度从术前90．0°±9．87°（65°～110°）改善至末次随访的115．0°±10．08°（95°-135°），差异均有统计学意义（P值均〈0．01）。随访中，除了2例仍存在5°屈曲挛缩外，其余53例膝关节均能完全伸直，未发现膝关节失稳病例，未发现感染、下肢深静脉血栓及其他并发症。结论 TKA术中采用多针穿刺松解技术，可以通过增加穿刺次数逐渐延长MCL，增加内侧间隙，从而获得满意的软组织平衡，

Multiple needle puncture technique releasing medial collateral ligament for soft tissue balance in total knee arthroplasty of moderate varus knees

Objective To analyze the efficacy and safety of the multiple needle puncture technique for soft tissue balance in total knee arthroplasty （TKA） of moderate varus knee by releasing the medial collateral ligament（MCL）. Methods To review fifty-five patients of moderate varus knee osteoarthritis with the technique of multiple needle puncture in TKA in Shanghai Sixth People＇s Hospital Affiliated to Shanghai Jiaotong University from January to June 2013, including 19 males and 35 females. The average age was 63.4 years （ range, 57 - 79 years）. Fifty-five patients were treated with KTA and the multiple needle puncture technique for soft tissue balance in operation of moderate varus knee by releasing the MCL. Postoperative rehabilitation exercises were carried out strictly. Clinical follow-up included range of motion of knee and standard Knee Society knee and functional scoring, as well as evaluation of mediolateral stability using maximal manual stress testing. Full leg standing radiographs were obtained 3 weeks after the operation and standard standing radiographs of the knee at each follow-up visit of 3 months, 6 months and 1 year. The average follow-ups were fourteen months. Preoperative and postoperative knee alignment, American knee society score（KSS） and the range of motion of knee were analyzed. Results All 55 patients obtained satisfying soft tissue balance intra-operatively, with none over-releasing medially. Mechanical alignment as measured on standing full leg radiographs improved from 13.5°± 3.36° varus （ range, 9° - 25° varus） preoperatively to 0.8° ±1.07° varus （range, 3.5° varus to 2° valgns） postoperatively. The average KSS improved from 39.9 ± 7.84 （ range, 20 - 65 ） preoperatively to 94.0 ± 7.27 （ range, 65 - 100 ） at final follow-up, and the function score improved from 35.2 ± 10.51 （range, 20 - 80） preoperatively to 85.0 ± 10.84（ range, 50- 100） at final follow-up. Average flexion improved from 90.0° ±9.87° （range, 65° - 110° ） preopera