外侧副韧带松弛的内翻膝患者在TKA术中的胫骨截骨量分析

doi:10.13418/j.issn.1001-165x.2021.04.018

摘要/Abstract

摘要： 目的　探讨合并外侧副韧带松弛的内翻膝患者的截骨量是否受影响。方法　选取本院2016年至2018年行膝关节置换的内翻膝患者92例，其中25例合并外侧副韧带松弛的患者为观察组；其余患者为对照组。两组均采用等量截骨法进行截骨。术中测量股骨远端外髁、股骨后外髁、胫骨外侧平台截骨量，随访测量胫股解剖角（anatomic tibiofemoral angle，ATFA）、髌骨倾斜角（patellar tilt angle，PTA）、股骨后髁偏距（posterior condylar offset，PCO）。采用美国膝关节协会评分（AKS）、美国特种外科医院（HSS）评分以及关节活动度评价关节功能。结果　两组股骨远端外髁截骨量差异无统计学意义（P>0.05），观察组术中胫骨外侧平台截骨量低于对照组（P<0.05）。两组患者术后6周、6个月及12个月ATFA、PTA、PCO、AKS评分、HSS评分及膝关节活动度无统计学差异（P>0.05）。结论　合并外侧副韧带松弛的内翻膝患者的胫骨外侧平台截骨量较小。

关键词: 外侧副韧带松弛, 　内翻膝, 　膝关节置换

Abstract: Objective　To investigate whether osteotomy of varus knee patients with lateral collateral ligament relaxation is affected.　Methods　Ninety-two patients with varus knee joint replacement went to our hospital from 2016 to 2018 were selected, among which 25 patients with lateral collateral ligament relaxation were as an observation group and the rest were as a control group. Both groups were treated with equal osteotomy. The osteotomy of the distal femoral condyle, the posterior femoral condyle and the lateral tibial plateau were measured during the operation. Anatomic tibiofemoral angle (ATFA), patellar tilt angle (PTA) and posterior condylar offset (PCO) were measured during the follow-up. The joint function was evaluated by the American Knee association score (AKS), the American Special Surgery Hospital (HSS) score and joint mobility.　Results　There was no significant difference in the osteotomy of the distal femoral condyle between the two groups (P>0.05). The osteotomy of the lateral tibial plateau in the observation group was lower than that in the control group (P<0.05). There was no statistical difference in ATFA, PTA, PCO, AKS, HSS and knee activity at 6 weeks, 6 months and 12 months after operation between the two groups (P>0.05).　Conclusions　The patients with varus knee combined with lateral collateral ligament relaxation had less osteotomy volume of the lateral tibial plateau .

Key words: Lateral collateral ligament relaxation, 　Varus knee, 　Knee replacement

中图分类号:

R687.4

戴章生, 林晓聪, 方凯彬, 施少坚. 外侧副韧带松弛的内翻膝患者在TKA术中的胫骨截骨量分析[J]. 中国临床解剖学杂志, 2021, 39(4): 460-464.

Dai Zhangsheng, Lin Xiaocong, Fang Kaibin, Shi Shaojian. Analysis of tibial osteotomy in varus knee patients with lateral collateral ligament relaxation during TKA[J]. Chinese Journal of Clinical Anatomy, 2021, 39(4): 460-464.

参考文献 26

[1]	Jeong BO, Kim TY, Baek JH, et al. Following the correction of varus deformity of the knee through total knee arthroplasty, significant compensatory changes occur not only at the ankle and subtalar joint, but also at the foot[J]. Knee Surg Sports Traumatol Arthrosc, 2018, 26(11): 3230-3237. DOI: 10.1007/s00167-018-4840-7.
[2]	Bayliss LE, Culliford D, Monk AP, et al. The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study[J]. Lancet, 2017, 389(10077): 1424-1430. DOI: 10.1016/S0140-6736(17)30059-4.
[3]	Puliero B, Favreau H, Eichler D, et al. Total knee arthroplasty in patients with varus deformities greater than ten degrees: survival analysis at a mean ten year follow-up[J]. Int Orthop, 2019, 43(2): 333-341. DOI: 10.1007/s00264-018-4019-3.
[4]	Sherman SL, Thompson SF, Clohisy JCF. Distal femoral varus osteotomy for the management of valgus deformity of the knee[J]. J Am Acad Orthop Surg, 2018, 26(9): 313-324. DOI: 10.5435/JAAOS-D-16-00179.
[5]	Brown GA. AAOS clinical practice guideline: treatment of osteoarthritis of the knee: evidence-based guideline, 2nd edition[J]. J Am Acad Orthop Surg, 2013, 21(9): 577-579. DOI: 10.5435/JAAOS-21-09-577.
[6]	Lee BS, Lee SJ, Kim JM, et al. No impact of severe varus deformity on clinical outcome after posterior stabilized total knee arthroplasty[J]. Knee Surg Sports Traumatol Arthrosc, 2011, 19(6): 960-966. DOI: 10.1007/s00167-010-1316-9.
[7]	Hart R, Štipčák V, Kučera B, et al. Precise, computed-assisted leg angle correction with open-wedge high tibial osteotomy[J]. Orthopade, 2007, 36(6): 577-581. DOI: 10.1007/s00132-007-1078-3.
[8]	Witoński D, Góraj B. Patellar motion analyzed by kinematic and dynamic axial magnetic resonance imaging in patients with anterior knee pain syndrome[J]. Arch Orthop Trauma Surg, 1999, 119(1-2): 46-49. DOI: 10.1007/s004020050353.
[9]	Bellemans J, Banks S, Victor J, et al. Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. Influence of posterior condylar offset[J]. J Bone Joint Surg Br, 2002, 84(1): 50-53. DOI: 10.1302/0301-620x.84b1.12432.
[10]	Hofmann AA, Kurtin SM, Lyons S, et al. Clinical and radiographic analysis of accurate restoration of the joint line in revision total knee arthroplasty[J]. J Arthroplasty, 2006, 21(8): 1154-1162. DOI: 10.1016/j.arth.2005.10.026.
[11]	Daines BK, Dennis DA. Gap balancing vs. measured resection technique in total knee arthroplasty[J]. Clin Orthop Surg, 2014, 6(1): 1-8. DOI: 10.4055/cios.2014.6.1.1.
[12]	Liow RYL, Walker K, Wajid MA, et al. The reliability of the American Knee Society Score[J]. Acta Orthopaedica Scandinavica, 2000, 71(6): 603-608. DOI: 10.1080/000164700317362244.
[13]	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]. J Bone Joint Surg Am, 1982, 64(3): 347-351. PMID: 7061551.
[14]	Paxton EW, Furnes O, Namba RS, et al. Comparison of the Norwegian knee arthroplasty register and a United States arthroplasty registry[J]. J Bone Joint Surg Am, 2011, 93 (Suppl 3): S20-S30. DOI: 10.2106/JBJS.K.01045.
[15]	Muratsu H, Matsumoto T, Kubo S, et al. Femoral component placement changes soft tissue balance in posterior-stabilized total knee arthroplasty[J]. Clin Biomech (Bristol Avon), 2010, 25(9): 926-930. DOI: 10.1016/j.clinbiomech.2010.06.020.
[16]	Lee JK, Lee S, Kim D, et al. Revision total knee arthroplasty with varus-valgus constrained prosthesis versus posterior stabilized prosthesis[J]. Knee Surg Sports Traumatol Arthrosc, 2013, 21(3): 620-628. DOI: 10.1007/s00167-012-1998-2.
[17]	Andrawis JP, Bozic KJ. Health policy and financial issues related to new total knee arthroplasty technology[J]. Tech Orthop, 2018, 33(1): 7-10. DOI: 10.1097/BTO.0000000000000263.
[18]	McCartney W, MacDonald B, Ober CA, et al. Pelvic modelling and the comparison between plate position for double pelvic osteotomy using artificial cancellous bone and finite element analysis[J]. BMC Vet Res, 2018, 14(1): 100. DOI: 10.1186/s12917-018-1416-1.
[19]	Springer BD, Parratte S, Abdel MP. Measured resection versus gap balancing for total knee arthroplasty[J]. Clin Orthop Relat Res, 2014, 472(7): 2016-2022. DOI: 10.1007/s11999-014-3524-y.
[20]	Churchill JL, Khlopas A, Sultan AA, et al. Gap-Balancing versus measured resection technique in total knee arthroplasty: a comparison study[J]. J Knee Surg, 2018, 31(1): 13-16. DOI: 10.1055/s-0037-1608820.
[21]	Dennis DA, Komistek RD, Raymond H Kim, et al. Gap balancing versus measured resection technique for total knee arthroplasty[J]. Clin Orthop Relat Res, 2010, 468(1): 102-107. DOI: 10.1007/s11999-009-1112-3.
[22]	Seo SS, Kim CW, Lee CR, et al. Does final component alignment correlate with alignment of the bone resection surfaces in cemented total knee arthroplasty[J]? Knee Surg Sports Traumatol Arthrosc, 2018, 26(5): 1436-1444. DOI: 10.1007/s00167-016-4371-z.
[23]	王建平. 膝关节力学建模与屈曲运动生物力学特性研究[D]. 上海: 上海交通大学, 2010.
[24]	Friesenbichler J, Leithner A, Glehr M, et al. Evaluation of stability of rotating hinge knee prostheses: a biomechanical study[J]. ISRN Orthop, 2013, 2013: 701693. DOI: 10.1155/2013/701693.
[25]	Girard J, Amzallag M, Pasquier G, et al. Total knee arthroplasty in valgus knees: Predictive preoperative parameters influencing a constrained design selection[J]. OrthopTraumatol Surg Res, 2009, 95(4): 260-266. DOI: 10.1016/j.otsr.2009.04.005.
[26]	Meftah M, Blum YC, Raja D, et al. Correcting fixed varus deformity with flexion contracture during total knee arthroplasty: the "inside-out" technique: AAOS exhibit selection[J]. J Bone Joint Surg Am, 2012, 94(10): e66. DOI: 10.2106/JBJS.K.01444.