人工全膝關節置換術治療終末期膝關節病變合并膝外翻畸形的手術技巧及臨床療效評價_《中國修復重建外科雜志》

作者：

王興山 , 翁習生 , 林進 , 金今 , 錢文偉

中國醫學科學院北京協和醫學院北京協和醫院骨科（北京，100730）;

關鍵詞：

人工全膝關節置換膝關節病變膝外翻畸形髕旁內側入路

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目的探討對終末期膝關節病變合并膝外翻畸形患者行經髕旁內側入路人工全膝關節置換（total knee arthroplasty，TKA）時膝外翻畸形矯正方法及臨床療效。方法 1998 年11 月－ 2010 年10 月，收治64 例72 膝合并膝外翻畸形的終末期膝關節病變患者。男18 例，女46 例；年齡23 ～ 82 歲，平均62.5 歲。骨關節炎44 例49 膝，類風濕性關節炎17 例20 膝，血友病性關節炎2 例2 膝，創傷性關節炎1 例1 膝。雙膝8 例，單膝56 例。膝關節屈伸活動度為（82.2 ± 28.7）°，X 線片測量股脛角為（18.0 ± 5.8）°。膝關節學會評分系統（KSS）臨床評分為（31.2 ± 10.1）分，功能評分（37.3 ± 9.0）分。根據Krackow 膝外翻分型標準：Ⅰ型65 膝，Ⅱ型7 膝。手術經髕旁內側入路，采用常規方法行股骨及脛骨截骨，Ranawat 技術進行軟組織松解。6 例7 膝采用保留后交叉韌帶型假體，54 例60 膝采用后穩定型假體，4 例5 膝采用髁限制型假體。結果術后患者切口均Ⅰ期愈合。1 例血友病性關節炎合并嚴重膝外翻畸形（股脛角41°）、屈曲攣縮20° 的患者術后出現腓總神經麻痹，經保守治療1 年后神經功能恢復。1 例術后2 年發生深部感染，行二期翻修術后治愈。患者術后均獲隨訪，隨訪時間1 ～ 13 年，平均4.9 年。末次隨訪時X 線片示股脛角為（7.0 ± 2.5）°，與術前比較差異有統計學意義（t=15.502，P=0.000）。KSS 臨床評分為（83.0 ± 6.6）分，功能評分（85.1 ± 10.5）分，膝關節屈伸活動度為（106.1 ± 17.0）°，與術前比較差異均有統計學意義（P lt; 0.05）。5 例遺留12 ～ 15° 膝外翻畸形，但患膝關節功能良好。結論通過恰當的術中截骨和軟組織平衡，采用經髕旁內側入路TKA 治療合并膝外翻畸形的終末期膝關節病變可有效
改善膝外翻畸形和恢復關節功能，臨床療效滿意。

引用本文： 王興山,翁習生,林進,金今,錢文偉. 人工全膝關節置換術治療終末期膝關節病變合并膝外翻畸形的手術技巧及臨床療效評價. 中國修復重建外科雜志, 2012, 26(5): 513-517. doi: 復制

1.	Koskinen E, Remes V, Paavolainen P, et al. Results of total knee replacement with a cruciate-retaining model for severe valgus deformity—a study of 48 patients followed for an average of 9 years. Knee, 2011, 18(3): 145-150.
2.	Kamath AF, Israelite C, Horneff J, et al. Editorial: What is varus or valgus knee alignment?: a call for a uniform radiographic classification. Clin Orthop Relat Res, 2010, 468(6): 1702-1704.
3.	Krackow KA, Jones MM, Teeny SM, et al. Primary total knee arthroplasty in patients with fixed valgus deformity. Clin Orthop Relat Res, 1991, (273): 9-18.
4.	Aglietti P, Sensi L, Cuomo P, et al. Rotational position of femoral and tibial components in TKA using the femoral transepicondylar axis. Clin Orthop Relat Res, 2008, 466(11): 2751-2755.
5.	Ranawat AS, Ranawat CS, Elkus M, et al. Total knee arthroplasty for severe valgus deformity. J Bone Joint Surg (Am), 2005, 87 Suppl 1(Pt 2): 271-284.
6.	暢怡, 周殿閣. 初次全膝關節置換術中韌帶加強技術的應用. 中華醫學雜志, 2009, 89(21): 1509-1511.
7.	Williot A, Rosset P, Favard L, et al. Total knee arthroplasty in valgus knee. Orthop Traumatol Surg Res, 2010, 96(4 Suppl): S37-S42.
8.	Krackow KA, Phillips MJ, Mihalko WM. Ligament advancement techniques in primary and revision total knee arthroplasty. Tech Knee Surg, 2003, 2(3): 138-143.
9.	Stern SH, Moeckel BH, Insall JN. Total knee arthroplasty in valgus knees. Clin Orthop Relat Res, 1991, (273): 5-8.
10.	Hirschmann MT, Hoffmann M, Krause R, et al. Anterolateral approach with tibial tubercle osteotomy versus standard medial approach for primary total knee arthroplasty: does it matter? BMC Musculoskeletal Disorders, 2010, 11: 167.
11.	Mertl P, Jarde O, Blejwas D, et al. Lateral approach of the knee with tibial tubercle osteotomy for prosthetic surgery. Rev Chir Orthop Reparatrice Appar Mot, 1992, 78(4): 264-267.
12.	Wolff AM, Hungerford DS, Krackow KA, et al. Osteotomy of the tibial tubercle during total knee replacement. A report of twenty-six cases. J Bone Joint Surg (Am), 1989, 71(6): 848-852.
13.	Miyasaka KC, Ranawat CS, Mullaji A. 10- to 20-year followup of total knee arthroplasty for valgus deformities. Clin Orthop Relat Res, 1997, (345): 29-37.
14.	Keblish PA. The lateral approach to the valgus knee. Surgical technique and analysis of 53 cases with over two-year follow-up evaluation. Clin Orthop Relat Res, 1991, (271): 52-62.
15.	Boyer P, Boublil D, Magrino B, et al. Total knee replacement in the fixed valgus deformity using a lateral approach: role of the automatic iliotibial band release for a successful balancing. Int Orthop, 2009, 33(6): 1577-1583.
16.	Girard J, Amzallag M, Pasquier G, et al. Total knee arthroplasty in valgus knees: predictive preoperative parameters influencing a constrained design selection. Orthop Traumatol Surg Res, 2009, 95(4): 260-266.
17.	Lachiewicz PF, Soileau ES. Results of a second-generation constrained condylar prosthesis in primary total knee arthroplasty. J Arthroplasty, 2011, 26(8): 1228-1231.
18.	劉軍, 孫振輝, 張宇, 等. 改良Ranawat軟組織松解平衡技術在外翻畸形全膝關節置換術中的應用. 中國修復重建外科雜志, 2009, 23(9): 1034-1037.
19.	Idusuyi OB, Morrey BF. Peroneal palsy after total knee arthroplasty. Assessment of predisposing and prognostic factors. J Bone Joint Surg (Am), 1996, 78(2): 177-184.
20.	Mihalko WM, Krackow KA. Anatomic and biomechanical aspects of pie crusting posterolateral structures for valgus deformity correction in total knee arhtroplasty: a cadaveric study. J Arthroplasty, 2000, 15(3): 347-353.
21.	Rose HA, Hood RW, Otis JC, et al. Peroneal-nerve palsy following total knee arthroplasty. A review of the hospital for special surgery experience. J Bone Joint Surg (Am), 1982, 64(3): 347-351.

1. Koskinen E, Remes V, Paavolainen P, et al. Results of total knee replacement with a cruciate-retaining model for severe valgus deformity—a study of 48 patients followed for an average of 9 years. Knee, 2011, 18(3): 145-150.
2. Kamath AF, Israelite C, Horneff J, et al. Editorial: What is varus or valgus knee alignment?: a call for a uniform radiographic classification. Clin Orthop Relat Res, 2010, 468(6): 1702-1704.
3. Krackow KA, Jones MM, Teeny SM, et al. Primary total knee arthroplasty in patients with fixed valgus deformity. Clin Orthop Relat Res, 1991, (273): 9-18.
4. Aglietti P, Sensi L, Cuomo P, et al. Rotational position of femoral and tibial components in TKA using the femoral transepicondylar axis. Clin Orthop Relat Res, 2008, 466(11): 2751-2755.
5. Ranawat AS, Ranawat CS, Elkus M, et al. Total knee arthroplasty for severe valgus deformity. J Bone Joint Surg (Am), 2005, 87 Suppl 1(Pt 2): 271-284.
6. 暢怡, 周殿閣. 初次全膝關節置換術中韌帶加強技術的應用. 中華醫學雜志, 2009, 89(21): 1509-1511.
7. Williot A, Rosset P, Favard L, et al. Total knee arthroplasty in valgus knee. Orthop Traumatol Surg Res, 2010, 96(4 Suppl): S37-S42.
8. Krackow KA, Phillips MJ, Mihalko WM. Ligament advancement techniques in primary and revision total knee arthroplasty. Tech Knee Surg, 2003, 2(3): 138-143.
9. Stern SH, Moeckel BH, Insall JN. Total knee arthroplasty in valgus knees. Clin Orthop Relat Res, 1991, (273): 5-8.
10. Hirschmann MT, Hoffmann M, Krause R, et al. Anterolateral approach with tibial tubercle osteotomy versus standard medial approach for primary total knee arthroplasty: does it matter? BMC Musculoskeletal Disorders, 2010, 11: 167.
11. Mertl P, Jarde O, Blejwas D, et al. Lateral approach of the knee with tibial tubercle osteotomy for prosthetic surgery. Rev Chir Orthop Reparatrice Appar Mot, 1992, 78(4): 264-267.
12. Wolff AM, Hungerford DS, Krackow KA, et al. Osteotomy of the tibial tubercle during total knee replacement. A report of twenty-six cases. J Bone Joint Surg (Am), 1989, 71(6): 848-852.
13. Miyasaka KC, Ranawat CS, Mullaji A. 10- to 20-year followup of total knee arthroplasty for valgus deformities. Clin Orthop Relat Res, 1997, (345): 29-37.
14. Keblish PA. The lateral approach to the valgus knee. Surgical technique and analysis of 53 cases with over two-year follow-up evaluation. Clin Orthop Relat Res, 1991, (271): 52-62.
15. Boyer P, Boublil D, Magrino B, et al. Total knee replacement in the fixed valgus deformity using a lateral approach: role of the automatic iliotibial band release for a successful balancing. Int Orthop, 2009, 33(6): 1577-1583.
16. Girard J, Amzallag M, Pasquier G, et al. Total knee arthroplasty in valgus knees: predictive preoperative parameters influencing a constrained design selection. Orthop Traumatol Surg Res, 2009, 95(4): 260-266.
17. Lachiewicz PF, Soileau ES. Results of a second-generation constrained condylar prosthesis in primary total knee arthroplasty. J Arthroplasty, 2011, 26(8): 1228-1231.
18. 劉軍, 孫振輝, 張宇, 等. 改良Ranawat軟組織松解平衡技術在外翻畸形全膝關節置換術中的應用. 中國修復重建外科雜志, 2009, 23(9): 1034-1037.
19. Idusuyi OB, Morrey BF. Peroneal palsy after total knee arthroplasty. Assessment of predisposing and prognostic factors. J Bone Joint Surg (Am), 1996, 78(2): 177-184.
20. Mihalko WM, Krackow KA. Anatomic and biomechanical aspects of pie crusting posterolateral structures for valgus deformity correction in total knee arhtroplasty: a cadaveric study. J Arthroplasty, 2000, 15(3): 347-353.
21. Rose HA, Hood RW, Otis JC, et al. Peroneal-nerve palsy following total knee arthroplasty. A review of the hospital for special surgery experience. J Bone Joint Surg (Am), 1982, 64(3): 347-351.

《中國修復重建外科雜志》

人工全膝關節置換術治療終末期膝關節病變合并膝外翻畸形的手術技巧及臨床療效評價

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《中國修復重建外科雜志》

人工全膝關節置換術治療終末期膝關節病變合并膝外翻畸形的手術技巧及臨床療效評價

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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