摘要
目的 :探讨外移股骨开髓点并设置个性化股骨外翻角能否改善合并股骨外弓的人工全膝关节置换术(total knee arthroplasty,TKA)患者下肢力线。方法:2016年3月至2018年10月,收治50例(55膝)合并股骨外弓拟行TKA的膝内翻畸形的骨关节炎患者。男10例,女40例;年龄63.1~80.5(67.8±5.8)岁。单侧45例,双侧5例。55膝的骨关节炎分期均为Kellgren-Lawrence分级Ⅲ-Ⅳ级,病程2~10年。术前特种外科医院(Hospital for Special Surgery,HSS)评分疼痛(15.20±3.52)分,功能(8.30±2.96)分,活动度(10.15±2.85)分,肌力(4.20±1.95)分,屈曲畸形(5.50±3.05)分,稳定性(6.15±2.20)分,总分(47.93±3.39)分。股骨外弓角6.4~16.7 (10.63±2.29)°,胫股角7.4~12.6 (12.04±3.59)°,解剖股骨远端外侧角83.10~91.20(84.55±1.66)°,膝关节中心至下肢力线距离2.01~6.00(3.57±1.12)cm。置换术中均通过个性化设置股骨开髓点与外翻角,获得良好下肢力线。结果:术前股骨开髓点外移距离0.24~0.74(0.54±0.10)cm,股骨内外髁间距离6.86~8.12 (7.27±0.27)cm。术前股骨外翻角(valgus correction angle,VCA)7.20~13.80 (9.38±1.38)°;矫正后VCA’6.10~9.50(7.36±0.82)°。50例患者均获随访,时间3~36(13.5±5.8)个月。术后患者均获得良好的膝关节功能,术后3个月HSS评分疼痛(25.30±3.05)分,功能(18.25±2.05)分,活动度(16.05±0.75)分,肌力(6.20±2.10)分,屈曲畸形(8.80±1.85)分,稳定性(8.20±1.75)分,总分90.00~93.00(91.82±0.98)分,总分较术前提高(t=1.728,P=0.038)。术后X线片复查示,假体没有松动、下沉及骨溶解等征象发生;术后第2天负重位X线片上胫股角1.30~4.90(2.53±0.83)°,解剖股骨远端外侧角87.50~91.30(88.73±0.86)°,膝关节中心至下肢力线距离0.02~1.20(0.23±0.05) cm,均较术前改善(t=2.415,P=0.019;t=1.496,P=0.041;t=1.912,P=0.033)。结论:合并股骨外弓的TKA中通过外移股骨开髓点并设置个性化股骨外翻角能获得良好的下肢力线和膝关节功能。
Objective:To investigate whether shifting the femoral opening point and setting a personalized femoral valgus angle can improve the lower limb force line of total knee arthroplasty(TKA) patients with external femoral arch.Methods:From March 2016 to October 2018,50 patients(55 knees) with osteoarthritis with genu varus deformity combined with external femoral arch for TKA were selected.There were 10 males and 40 females.The age ranged from 63.1 to 80.5 years old,with an average of(67.8±5.8) years old.Forty-five cases were unilateral and 5 cases were bilateral.The osteoarthritis stages of 55 knees were Kellgren-Lawrence grade Ⅱ to Ⅳ;and the course of disease ranged from 2 to 10 years.Preoperative Special Surgery(Hospital for Special Surgery) scores:pain was 15.20±3.52;function was 8.30±2.96;mobility was 10.15±2.85;muscle strength was 4.20±1.95;flexion deformity was 5.50±3.05;stability was 6.15±2.20;total score was 47.93±3.39.The external femoral arch angle ranged from 6.4° to 16.7°,with a mean of(10.63±2.29)°.The tibiofemoral angle ranged from 7.40 to 12.60,with a mean of(12.04±3.59)°.The anatomical distal femoral angle ranged from 83.100 to 91.20°,with a mean of(84.55±1.66)°.And the distance from the center of the knee joint to the lower limb line of force ranged from 2.01 to 6.00 cm,with a mean of(3.57±1.12) cm.During the replacement surgery,the femoral opening point and the valgus angle were individually set to obtain a good line of force of the lower limbs.Results:Before the operation,the distance of femoral opening point ranged from 0.24 to 0.74 cm,with a mean of(0.54±0.10) cm.The distance between the internal and external condyles of the femur ranged from 6.86 to 8.12 cm,with a mean of(7.27±0.27) cm.The preoperative valgus correction angle(VCA) ranged from7.20° to 13.80°,with a mean of(9.38±1.38)°.The post-correction valgus correction angle’(VCA’) ranged from 6.10° to9.50°,with a mean of(7.36±0.82)°.All patients were followed up,and the duration ranged from 3 to 36 months,with an average of(13.5±5.8) months.All patients obtained good knee function after operation.Three months after operation,HSS scores included pain of 25.30±3.05,function of 18.25±2.05,mobility of 16.05±0.75,muscle strength of 6.20±2.10,flexion deformity of 8.80±1.85 stability of 8.20±1.75;and the total score ranged from 90.00 to 93.00,with an average of 91.82±0.98.The total score was higher than that before operation(t=1.728,P=0.038).Postoperative X-ray examination showed that there were no signs of loosening,sinking,or osteolysis of the prosthesis.The tibiofemoral angle on the weight-bearing X-ray on the second day after surgery ranged from 1.30° to 4.90°,with a mean of(2.53±0.83)°;the angle ranged from 87.50° to 91.30°,with a mean of(88.73±0.86)°;and the distance from the center of the knee joint to the lower limb line of force ranged from 0.02 cm to 1.20 cm,with a mean of(0.23±0.05) cm;which were improved compared with those before operation(t=2.415,P=0.019;t=1.496,P=0.041;t=1.912,P=0.033).Conclusion:In TKA combined with external femoral arch,good lower limb force line and knee joint function can be obtained by externally shifting the femoral opening point and setting a personalized femoral valgus angle.
作者
罗涛
周勇刚
孙菁阳
LUO Tao;ZHOU Yong-gang;SUN Jing-yang(Department of Joint Surgery,the First Center of General Hospital of the People's Liberation Army,Bejing 100853,China)
出处
《中国骨伤》
CAS
CSCD
2021年第12期1147-1152,共6页
China Journal of Orthopaedics and Traumatology
关键词
关节成形术
置换
膝
股骨外翻角
股骨外弓
下肢力线
Arthroplasty
replacement
knee
Valgus correction angle
Lateral bowing femur
Limb alignment
