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直接外侧结构松解术治疗重度膝关节外翻畸形

任姜栋 曹力

任姜栋, 曹力. 直接外侧结构松解术治疗重度膝关节外翻畸形[J]. 协和医学杂志, 2018, 9(2): 160-164. doi: 10.3969/j.issn.1674-9081.2018.02.011
引用本文: 任姜栋, 曹力. 直接外侧结构松解术治疗重度膝关节外翻畸形[J]. 协和医学杂志, 2018, 9(2): 160-164. doi: 10.3969/j.issn.1674-9081.2018.02.011
Jiangdong Ren, Li Cao. Correcting Severe Valgus Deformity with the Method of Direct Lateral Soft Structure Release in Total Knee Arthroplasty[J]. Medical Journal of Peking Union Medical College Hospital, 2018, 9(2): 160-164. doi: 10.3969/j.issn.1674-9081.2018.02.011
Citation: Jiangdong Ren, Li Cao. Correcting Severe Valgus Deformity with the Method of Direct Lateral Soft Structure Release in Total Knee Arthroplasty[J]. Medical Journal of Peking Union Medical College Hospital, 2018, 9(2): 160-164. doi: 10.3969/j.issn.1674-9081.2018.02.011

直接外侧结构松解术治疗重度膝关节外翻畸形

doi: 10.3969/j.issn.1674-9081.2018.02.011
详细信息
    通讯作者:

    曹力  电话:099-14365444, Email:xjbone@21cn.com

  • 中图分类号: R682.6

Correcting Severe Valgus Deformity with the Method of Direct Lateral Soft Structure Release in Total Knee Arthroplasty

More Information
  • 摘要:   目的  探讨直接外侧结构[外侧副韧带(lateral collateral ligament,LCL)+腘肌腱(popliteus,Pop)+髂胫束(iliotibial band,ITB)]松解方法应用于重度膝关节外翻畸形患者人工全膝关节置换术(total knee arthroplasty, TKA)的临床效果。  方法  2007年1月至2014年12月,新疆医科大学第一附属医院收治的因重度膝关节外翻畸形采用直接外侧结构松解方法行TKA手术的患者28例(30膝),其中男性8例,女性20例;年龄41~80岁,平均(66.7±11.1)岁;骨性关节炎23例,类风湿关节炎5例,合并髌骨完全脱位2例,内侧不稳定1例。28例(30膝)患者术中均采用直接外侧结构松解方法以获得膝关节平衡。仅2膝彻底松解了Pop,所有患者均松解了LCL和ITB。随访采用X线检查测量膝关节股胫角度数评价外翻改善程度,采用美国特种外科医院(the Hospital for Special Surgery,HSS)关节评分评估膝关节功能,采用双下肢站立位全长X线及膝关节正侧位X线检查测量下肢力线并评价假体位置。  结果  术后平均随访2 ~8年,HSS评分从术前(20.4±14.3)分(6~38分)提高至末次随访时(89.5±9.4)分(83~96分),P<0.001;股胫角由术前(32.6± 4.3)°(22°~42°)降至末次随访时(7.6±3.7)°(0°~10°),P=0.001。术后1例患者膝关节外侧不稳,给予膝关节支具保护3个月后症状消失,4例术后出现腓总神经麻痹,术后3个月复查症状消失,未发生感染、松动、血栓等并发症。  结论  对于重度膝关节外翻畸形患者,按顺序直接外侧结构松解方法安装后稳定型假体,可取得满意的临床效果。
  • 图  1  在内翻张力作用下,用电刀渐进松解外侧副韧带在股骨的止点(A),边松解,边检查,直至完全松解(B)

    图  2  与术前(A)相比,术后(B)膝关节外翻畸形基本得到矫正,术后一年功能良好

    表  1  28例患者术前及术后末次随访HSS评分及股胫角比较

    病例 HSS评分(分) 股胫角(°) 随访时间(年) 并发症
    术前 术后 术前 术后
    1 18 86 31 8 5.8
    2 19 86 30 8 6.9
    3 25 90 23 7 8.0
    4 22 84 26 7 6.1
    5 32 90 23 6 7.5
    6 30 84 28 8 7.1
    7 26 93 28 9 8.0
    8 20 90 32 9 7.3
    9 38 96 22 0 6.6
    10 6 90 42 10 7.1
    11 11 83 38 9 6.2
    12 13 95 36 8 6.1
    13 12 92 37 9 6.0
    14 10 92 39 9 4.3
    15 20 92 32 9 5.0
    16 22 86 26 8 3.5
    17 25 89 23 6 2.0
    18 8 90 41 10 3.8
    19 17 88 31 8 5.6
    20 24 85 26 6 6.2
    21 23 91 25 7 3.0
    22 23 89 25 5 5.2
    23 21 90 27 8 7.0
    24 9 88 40 10 7.3
    25 30 93 29 7 6.1
    26 29 93 29 7 4.5
    27 22 95 26 6 6.3
    28 16 87 32 9 5.0
    HSS:美国特种外科医院
    下载: 导出CSV
  • [1] Nikolopoulos D, Michos I, Safos G, et al. Current surgical strategies for total arthroplasty in valgus knee[J]. World J Orthop, 2015, 6:469-482. doi:  10.5312/wjo.v6.i6.469
    [2] Ranawat AS, Ranawat CS, Elkus M, et al. Total knee arthroplasty for severe valgus deformity[J]. J Bone Joint Surg Am, 2005, 87:271-284. doi:  10.2106/00004623-200509001-00010
    [3] Engh GA. The difficult knee: severe varus and valgus[J]. Clin Orthop Relat Res, 2003, 416:58-63. doi:  10.1097/01.blo.0000092987.12414.fc
    [4] Whiteside LA. Selective ligament release in total knee arthroplasty of the knee in valgus[J].Clin Orthop Relat Res, 1999, 367:130-140. doi:  10.1097/00003086-199910001-00013
    [5] Mullaji AB, Shetty GM. Lateral epicondylar osteotomy using computer navigation in total knee arthroplasty for rigid valgus deformities[J]. J Arthroplasty, 25:166-169. doi:  10.1016/j.arth.2009.06.013
    [6] Easley ME, Insall JN, Scuderi GR, et al. Primary constrained condylar knee arthroplasty for the arthritic valgus knee[J]. Clin Orthop, 2000, 380:58-64. doi:  10.1097/00003086-200011000-00008
    [7] Krackow KA, Mihalko WM.Flexion-extension joint gap changes after lateral structure release for valgus deformity correction in total knee arthroplasty: a cadaveric study[J]. J Arthroplasty, 1999, 14:994-1004. doi:  10.1016/S0883-5403(99)90016-5
    [8] Lombardi AV Jr, Dodds KL, Berend KR, et al. An algorithmic approach to total knee arthroplasty in the valgus knee[J]. J Bone Joint Surg Am, 2004, 86:62-71. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=WK_LWW2017052520744133
    [9] Lange J, Haas SB. Correcting severe valgus deformity: taking out the knock[J].Bone Joint J, 2017, 99:60-64. doi:  10.2106/JBJS.16.00792
    [10] Rossi R, Rosso F, Cottino U, et al. Total knee arthroplasty in the valgus knee [J]. Int Orthop, 2014, 38:273-283. doi:  10.1007/s00264-013-2227-4
    [11] Elkus M, Ranawat CS, Rasquinha VJ, et al. Total knee arthroplasty for severe valgus deformity. Five to fourteen-year follow-up[J]. J Bone Joint Surg Am, 2004, 86:2671-2676. doi:  10.2106/00004623-200412000-00013
    [12] Clarke HD, Fuchs R, Scuderi GR, et al.Clinical results in valgus total knee arthroplasty with the "Pie Crust" technique of lateral soft tissue releases[J].J Arthroplasty, 2005, 8:1010-1014. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=57fccbcef0e7848e983ced4b396abe01
    [13] Girard J, Amzallag M, Pasquier G, et al.Total knee arthroplasty in valgus knees:Predictive preoperative parameters influencing a constrained design selection[J]. Orthop Traumatol Surg Res, 2009, 95:260-266. doi:  10.1016/j.otsr.2009.04.005
    [14] Aglietti P, Lup D, Cuomo P, et al.Total knee arthroplasty using a pie-crusting technique for valgus deformity[J]. Clin Orthop, 2007, 464:73-77. doi:  10.1097/BLO.0b013e3181591c48
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出版历程
  • 收稿日期:  2017-07-13
  • 刊出日期:  2018-03-30

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