| 个性化截骨技术在严重膝内翻骨关节炎初次TKA中的应用价值分析 |
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投稿时间：2022-05-24
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| 作者 | Author | 单位 | Address | E-Mail |
| 闫英杰 |
YAN Ying-jie |
富平朱老二骨伤医院关节科, 陕西 富平 711700 |
Department of Arthrology, Fuping Zhulaoer Bone Injury Hospital, Fuping 711700, Shaanxi, China |
yanyingjie66@163.com |
| 贾刚 |
JIA Gang |
富平朱老二骨伤医院关节科, 陕西 富平 711700 |
Department of Arthrology, Fuping Zhulaoer Bone Injury Hospital, Fuping 711700, Shaanxi, China |
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| 白丁文 |
BAI Ding-wen |
富平朱老二骨伤医院关节科, 陕西 富平 711700 |
Department of Arthrology, Fuping Zhulaoer Bone Injury Hospital, Fuping 711700, Shaanxi, China |
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| 期刊信息：《中国骨伤》2023年，第36卷，第4期，第386-392页 |
| DOI：10.12200/j.issn.1003-0034.2023.04.017 |
| 基金项目: |
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中文摘要:
目的： 探讨个性化截骨技术在严重膝内翻骨关节炎初次全膝关节置换术(total knee arthroplasty,TKA)中的应用价值和疗效分析。
方法： 自2018年6月至2020年1月收治36例(49膝)严重膝内翻骨关节炎患者,男15例(21膝),女21例(28膝);年龄59~82(67.6±6.5)岁;病程9.5~20.5(15.0±4.5)年;骨关节炎Kellgren-Lawrence分级Ⅲ级11例(15膝),Ⅳ级25例(34膝);胫骨骨缺损分型AORI分型ⅠTa 8例(15膝),ⅡT2a型16例(18膝)。所有病例股-胫角(femor-tibial angle FTA)>15°,采用个性化截骨技术接受初次TKA,使用后稳定假体(posterior stability,PS)33例(45膝),PS假体胫骨侧联合使用金属垫块延长杆13例(15膝),髁限制性假体(legacy constrained condyarknee,LCCK)3例(4膝)。采用医院影像归档和通讯系统(picture archiving and communication systems,PACS)软件测量并比较术前和术后1个月FTA,股骨后髁角(posterior condylar angle,PCA),胫骨平台内侧角(medial proximal tibial angle,MPTA)、股骨远端外翻角(lateral distal femoral angle,LDFA),并采用美国膝关节协会评分(American Knee Society Score,KSS)评价术前及术后12个月下肢功能恢复情况,观察并记录并发症情况。
结果： 本组36例(49膝)均获得随访,时间15~40(23.46±7.65)个月。FTA、MPTA分别由术前的(18.65±4.28)°、(83.75±3.65)°,矫正到术后1个月的(2.35±1.46)°、(88.85±2.25)°(P<0.001)。PCA由术前(2.42±2.16)°,减小到术后1个月(1.65±1.35)°;术后1个月LDFA (91.63±3.38)°较术前(89.56±3.55)°增大(P<0.05)。KSS由术前的(67.58±24.16)分,提高到术后12个月的(171.31±15.24)分(P<0.001);其中优14例(19膝),良19例(26膝),可3例(4膝)。
结论： 个性化截骨技术,有助于下肢力线恢复和假体正确安放,可有效缓解膝关节疼痛,恢复膝关节功能,满意度高,为临床提供新选择。 |
| 【关键词】膝关节 全膝置换 下肢 膝内翻 |
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| Value of personalized osteotomy in primary total knee arthroplasty for severe varus knee osteoarthritis |
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ABSTRACT
Objective To explore application value and efficacy of personalized osteotomy in primary total knee arthroplasty (TKA) for severe varus knee osteoarthritis.
Methods From June 2018 to January 2020,36 patients (49 knees) with severe varus knee osteoarthritis were treated,including 15 males (21 knees) and 21 females (28 knees),aged from 59 to 82 years old with an average of (67.6 ±6.5) years old;the course of disease ranged from 9.5 to 20.5 years with an average of (15.0 ±5.0) years;11 patients (15 knees) with Kellgren-Lawrence grade Ⅲ and 25 patients (34 knees) with grade Ⅳ according to Kellgren-Lawrence grading. According to AORI clsssification of tibial bone defects,8 patients (15 knees) were typeⅠTa and 16 patients (18 knees) were typeⅡ T2a. All patients' femor-tibial angle (FTA) was above 15°,and received primary TKA with personalized osteotomy. Thirty-three patients (45 knees) were treated with posterior-stabilized (PS) prostheses,13 patients (15 knees) with PS prostheses combined with a metal pad and extension rod on the tibial side,and 3 patients (4 knees) with legacy constrained condylar knee (LCCK) prostheses. FTA,posterior condylar angle (PCA),medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA) before and after operation at 1 month were measured and compared by using picture archiving and communication systems (PACS). Recovery of lower limbs before and after operation at 12 months was evaluated by American Knee Society Score(KSS),and complications were observed and recorded.
Results All 36 patients (49 knees) were followed up from 15 to 40 months with an average of (23.46±7.65) months. FTA,MPTA were corrected from preoperative (18.65±4.28)° and (83.75±3.65)° to postoperative (2.35±1.46)° and (88.85±2.25)° at 1 month,respectively (P<0.001). PCA was decreased from (2.42±2.16)° before operation to (1.65±1.35)° at 1 month after operation,LDFA improved from (89.56 ±3.55)° before operation to (91.63±3.38)° at 1 month after operation (P<0.05). KSS increased from (67.58±24.16) before opertion to(171.31±15.24) at 12 months after operation,14 patients (19 knees) got excellent result,19 (26 knees) good,and 3 (4 knees) fair.
Conclusion Personalized osteotomy is helpful for recovery of axial alignment of lower limbs and correct placement of prosthesis,could effectively relieve pain of knee joint,recover knee joint function. |
| KEY WORDS Knee joint Total knee replacement Lower extremity Knee varus |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 闫英杰,贾刚,白丁文.个性化截骨技术在严重膝内翻骨关节炎初次TKA中的应用价值分析[J].中国骨伤,2023,36(4):386~392 |
| 英文格式: | YAN Ying-jie,JIA Gang,BAI Ding-wen.Value of personalized osteotomy in primary total knee arthroplasty for severe varus knee osteoarthritis[J].zhongguo gu shang / China J Orthop Trauma ,2023,36(4):386~392 |
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