【作者】 牛东生； 马军；

【机构】 宁夏人民医院骨科；

【摘要】 [目的 ]探讨在膝外翻畸形全膝关节置换术中应用个体化软组织平衡技术的临床效果及手术方法。[方法 ]膝外翻患者,术前X线测量股骨和胫骨解剖轴线夹角(FTA角),根据膝外翻畸形Keblish分级(轻度<15°;中度15°～30°;重度>30°),分为轻、中、重三级并认真评估患者软组织状况。软组织平衡术分为三步,第一步切开关节囊前行髂胫束苹果派样延长,第二步自胫骨结节骨膜下松解骼胫束止点和外侧副韧带,第三步自股骨侧松解外侧副韧带及后外侧关节囊。手术方法采用髌旁外侧入路,不同分级个体化的应用上述3步软组织平衡方法行全膝关节置换术。术后测量FTA角,术后定期随访行美国膝关节协会评价标准KSS评分及功能评分与术前比较,评价手术效果。[结果 ]2008年1月～2011年12月,20例(23膝)膝外翻患者,Keblish分级轻度8例8膝,中度7例10膝,重度5例5膝;轻、中、重三级患者应用个体化的软组织平衡方法实施TKA手术;所有患者均获得随访,随访时间6～48个月。术前术后FTA角及KSS评分、功能评分结果经SPSS14.0统计学软件做配对样本,t检验,差异均有统计学意义(P<0.01)。全部患者术后外翻畸形均得到完全矫正,关节稳定性良好。[结论 ]膝外翻畸形全膝关节置换术中选择个体化的软组织平衡方案,可以有效地矫正软组织失衡而获得满意的临床效果,同时又可以避免矫枉过正导致术后关节不稳。更多还原

【Abstract】 [Objective]To investigate the clinical efficacy and surgical methods of the Total Knee Arthroplasty(TKA) by personality soft tissue balance for volgus knee.[Method]To measure the tibial and femur angle(FTA) before the TKA operation,according to Keblish grade(mild < 15°;moderate 15°to 30; severe > 30°),divided the patients with volgus knee into mild,moderate, severe grade.Classified the soft tissue balance into three steps:The first,before the joint capsule was cut open,ilkrtibial band was prolonged by apple pie arthroplasty;The second,I-T band and lateral collateral ligament was released in Gerdy tubercle;The third,lateral collateral ligament and poster-lateral capsule was released from the femur side.TKA were performed by lateral parapatellar approach,personalized soft tissue balance according to the different grade.The average function Score,Knee Society Score System(KSS) and the FTA angle were performed at follow up and were compared with pre-operative. [Results]between January 2008 and December 2011,20 cases(23 knee),8 patients(8 knee) was of mide grade and 7 patients(10 knee) of moderate grade and 5 patients(5 knee) of severe grade.All patients were followed up for 6 to 48 months.TKA were performed by lateral parapatellar approach,personalized soft tissue balance according to the different grade.The post-operative average function Score,KSS and TKA were compared with pre-operative,Differences are all very notable(P<0.01).After operation,the valgus deformity of all patients were corrected and the knee stability was good.[Conclusion]The techniques of the Total Knee Arthroplasty by personality soft tissue balance volgus knee can correct a valgus deformity very successfully and avoid to overdo the joint instability.更多还原