摘要
目的分析髌旁外侧入路初次全膝关节置换术(total knee arthroplasty,TKA)治疗重度外翻膝畸形中期临床疗效及可能影响因素。方法2019年1月至2023年12月,我院采用初次TKA治疗重度外翻膝畸形(影像学评级为KL 4级)患者17例21膝(男5例,女12例),观察其早中期疗效。所有患者均采用髌旁外侧入路与后交叉韧带保留型(cruciate retaining,CR)膝关节假体。结果本组患者在手术时的影像学评级均为KL 4级,平均随访时间近46个月,随访中,除3例(发生率14.29%)出现肌间静脉血栓外,其余患者均未出现骨折、血管、神经、韧带损伤、深静脉血栓、肺栓塞、消化道溃疡、伤口感染或屈伸活动功能障碍、无菌性松动等严重并发症。TKA术中平均手术时间(105.71±12.80)min、平均出血量(140.71±34.07)ml,术后2天即可下床行走锻炼,均在术后1周恢复满意,并转至康复医院进行后续康复锻炼治疗。膝外翻畸形均获得显著改善,平均活动度(range of motion,ROM)、膝关节学会评分(Knee Society score,KSS)、西安大略和麦克马斯特大学骨关节炎调查量表(Western Ontario and McMaster Universities osteoarthritis index,WOMAC)评分、生活质量问卷(short form-12,SF-12)评分、疼痛视觉模拟评分(visual analogue scale,VAS)等获得显著提升,差异均有统计学意义。TKA术后1例患者报告持续12周的膝前外侧疼痛,经康复锻炼及封闭治疗后缓解,其余患者报告均满意,满意率95.23%。共有15例患者达到“遗忘膝”(71.43%),平均评分82.95±7.53。结论髌旁外侧入路TKA能有效矫正重度膝关节外翻畸形且中期疗效满意。
Objective To retrospectively analyze the mid-term clinical efficacy and possible influencing factors of primary total knee replacement by lateral parapatellar approach in the treatment of severe valgus knee deformity.Methods From January 2019 to December 2023,17 patients with severe valgus knee deformity who underwent primary total knee arthroplasty(TKA)to treat knee osteoarthritis were studied.All surgeries were completed by senior professional surgeons.Twenty-one knees(5 males and 12 females)were treated with TKA,and the early and mid-term effects were observed.All patients were treated with a lateral parapatellar approach and a posterior cruciate ligament-retaining(CR)knee prosthesis.Results The imaging rating of all patients at the time of surgery was KL 4,and all patients were followed up.The average follow-up time was nearly 46 months.During the follow-up,no intermuscular vein thrombosis occurred except for 3 cases(incidence rate 14.29%).The average operation time during TKA was(105.71±12.80)minutes,and the average blood loss was(140.71±34.07)ml.The patients were able to walk and exercise 2 days after the operation.All patients recovered satisfactorily 1 week after the operation and were transferred to a rehabilitation hospital for subsequent rehabilitation exercise treatment.The knee valgus deformity was corrected significantly after the surgery.ROM,KSS score,WOMAC score,SF-12 score,VAS score were improved significantly.After TKA,one patient reported anterolateral knee pain that lasted for 12 weeks,which was relieved after rehabilitation exercises and point injection treatment.The remaining 20 patients reported satisfaction,with a satisfaction rate of 95.23%.A total of 15 patients reached“forgotten knee”(71.43%),with an average score of(82.95±7.53).Conclusions Total knee arthroplasty through the lateral parapatellar approach can effectively correct severe knee valgus deformity,and the mid-term efficacy is satisfactory.
作者
张蔷
沈松坡
张轶超
ZHANG Qiang;SHEN Song-po;ZHANG Yi-chao(Department of Orthopedics,Beijing Tongren Hospital of the Capital Medical University,Beijing,100176,China)
出处
《中国骨与关节杂志》
CAS
2024年第9期730-736,共7页
Chinese Journal of Bone and Joint
关键词
关节成形术
置换
膝
膝外翻
骨关节炎
膝
后交叉韧带
Arthroplasty,replacement,knee
Genu valgum
Osteoarthritis,knee
Posterior cruciate ligament
