全膝关节置换术中股骨内髁滑移截骨治疗伴有关节外畸形的膝内翻

目的：探讨股骨内髁滑移截骨术（medial condyle sliding osteotomy, MCSO）在全膝关节置换术中纠正患者内翻膝关节外畸形的临床疗效。方法通过回顾性研究2013年1月至2015年12月在第三军医大学附属西南医院关节外科中心于全膝关节置换术中采用MCSO在关节内纠正股骨侧的关节外内翻畸形的12例患者，统计该组患者手术前后的股骨远端外侧力线角（mechanical lateral distal femoral angle, mLDFA）、髋-膝-踝（hip?knee?ankle, HKA）角、疼痛视觉模拟量表（visual analogue scale, VAS）评分及美国膝关节协会（American Knee Society, AKS）综合评分系统中的膝评分和功能评分等，评价MCSO纠正关节外的内翻畸形的效果。结果本组患者随访6~40个月，无感染、骨折、假体松动、截骨不愈合等并发症发生。本组患者手术前后的mLDFA分别为117.4°±4.7°、91.6°±1.4°；手术前后的HKA角分别为167.2°±9.8°、179.6°±1.6°；手术前后的VAS评分分别为（6.4±1.1）分、（1.8±1.5）分；手术前后的AKS膝评分分别为（60.2±17.6）分、（92.6±9.4）分；手术前后的AKS功能评分分别为（69.4±21.3）分、（87.6±14.9）分。手术前后以上指标的差异均有统计学意义（均P＜0.05）。结论在合并关节外畸形的内翻膝的关节置换手术中，采用MCSO技术可以正确纠正内翻力线，更容易实现伸屈间隙平衡，达到满意的手术疗效。能有效避免对膝关节后内侧和内侧组织结构的过度松解，从而避免单纯依赖软组织松解而导致的屈曲位内侧间隙松弛及髌股关节对位不良等问题。

Treatment of varus knee accompanied by extra-articular deformity with medial condyle sliding osteotomy in total knee arthroplasty

Objective To investigate the application of medial condyle sliding osteotomy (MCSO) in the treatment of the varus knee accompanied by extra?articular deformity in total knee arthroplasty (TKA). Methods The clinical data of 12 varus knee patients who received TKA with MCSO to correct the deformity from January 2013 to December 2015 in our center were retrospectively analyzed. The preoperative and post?operative mechanical lateral distal femoral angle (mLDFA), hip knee ankle (HKA) angle, and AKS scores in these 12 cases were collected. They were used to investigate the effect of correction of extra?articular varus deformity by MCSO. Results The patients were followed up for 6?40 months, and no infection, fracture, pros?thesis loosening, nonunion and other complications occurred. The preoperative mLDFA was 117.4°±4.7°, HKA angle was 167.2° ± 9.8° , VAS score was 6.4 ± 1.1, AKS knee score was 60.2 ± 17.6, and AKS function score was 69.4 ± 21.3. The postoperative mLDFA was 91.6° ± 1.4° , HKA angle was 179.6° ± 1.6° , VAS score was 1.8 ± 1.5, AKS knee score was 92.6 ± 9.4, and AKS function score was 87.6 ± 14.9. Conclusion It is effective to correct the varus alignment with extra?articular deformity by MCSO in TKA. MCSO in TKA could reduce over release of medial and post?medial structure, and make it easy to balance the extension and flexion gap. MCSO in TKA is much better than traditional release without causing patello femoral malalignment.