人工全膝关节置换术在外翻膝的临床应用Total knee replacement in valgus knee
徐美涛;查振刚;刘宁;叶永胜;苗贵强;李劼若;吴昊;林宏生;
摘要(Abstract):
[目的]探讨人工全膝关节置换术在外翻膝中的手术技术和临床疗效。[方法]2004年3月~2008年9月,对14例16个外翻膝行膝前正中、髌旁内侧入路,常规截骨、外侧软组织松解,后方稳定型假体或后交叉韧带保留型假体的人工全膝关节置换术进行回顾性研究。患者男3例,女11例,平均年龄60.5岁(45~77岁)。经过随访比较手术前后膝关节屈伸活动度、KSS评分、膝关节X线情况来评估手术临床效果。[结果]术后平均随访42个月(24~54个月),膝关节屈伸活动度由术前平均82°(伸直0°~屈曲120°)提高到术后120°(伸直0°~屈曲150°);KSS评分:临床评分由术前平均43分(10~65分)提高到术后平均83.9分(70~100分),功能评分由术前平均52.9分(30~70分)提高到术后平均89.3分(75~100分);胫股角由术前平均16.5°(8°~30°)改善到术后平均7°(5°~10°),膝外翻畸形得到良好的矫正。随访中无深静脉血栓、膝关节感染、髌骨半脱位或脱位并发症发生。[结论]膝前正中、髌旁内侧入路,常规截骨、外侧软组织松解,后方稳定型假体或后交叉韧带保留型假体的TKA治疗外翻膝临床疗效满意。
关键词(KeyWords): 人工全膝关节置换术;外翻膝;软组织平衡
基金项目(Foundation):
作者(Author): 徐美涛;查振刚;刘宁;叶永胜;苗贵强;李劼若;吴昊;林宏生;
Email:
DOI:
参考文献(References):
- [1]Ranawat AS,Ranawat CS,Elkus M,et al.Total knee arthroplasty for severevalgus deformity[J].J Bone Joint Surg Am,2005,87:271-284.
- [2]Elkus M,Ranawat CS,Rasquinha VJ,et al.Total knee arthroplasty forsevere valgus deformity.Five to fourteen-year follow-up[J].J BoneJoint Surg Am,2004,86:2671-2676.
- [3]Brilhault J,Lautman S,Favard L,et al.Lateral femoral sliding osteoto-my:lateral release in total knee arthroplasty for a fixed valgus deformity[J].J Bone Joint Surg Br,2002,84:1131-1137.
- [4]查振刚,黄春华,姚平,等.全膝置换术治疗伴膝外翻畸形膝骨性关节炎[J].中国医师进修杂志,2006,29:16-18.
- [5]Smith AJ,Wood DJ,Li MG.Total knee replacement with and withoutpatellar resurfacing:a prospective,randomised trial using the profix to-tal knee system[J].J Bone Joint Surg Br,2008,90:43-49.
- [6]Nilesh P,Kevin L,James I,et al.Patellar management in revision totalknee arthroplasty:is patellar resurfacing a better option[J].J Arthro-plasty,2010,25:589-593.
- [7]张启栋,郭万首,张倩,等.膝关节置换术中髌骨置换与非髌骨置换比较的Meta分析[J].中国矫形外科杂志,2010,18:17-21.
- [8]周一新,张洪,黄德勇,等.股骨假体设计对保留髌骨全膝关节置换术后膝前痛的影响[J].中华骨科杂志,2003,23:82-85.
- [9]Takehiko M,Ryosuke K,Seiji K,et al.Total knee arthroplasty com-bined with medial patellofemoral ligament reconstruction for osteoar-thritic knee with preoperative valgus deformity and chronic patellar dis-location[J].J Arthroplasty,2010,1:1-4.