[1]陈冰峰,孙立春.膝骨关节炎合并股骨侧弓患者全膝关节置换术后下肢机械轴对手术效果的影响[J].中医正骨,2022,34(07):22-26.
　CHEN Bingfeng,SUN Lichun.Effects of postoperative mechanical axis of the lower limb on the outcomes of total knee arthroplasty in patients with knee osteoarthritis and lateral femoral curvature[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(07):22-26.
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膝骨关节炎合并股骨侧弓患者全膝关节置换术后下肢机械轴对手术效果的影响()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期数:
2022年07期
页码:
22-26
栏目:
临床研究
出版日期:
2022-07-20

文章信息/Info

Title:
Effects of postoperative mechanical axis of the lower limb on the outcomes of total knee arthroplasty in patients with knee osteoarthritis and lateral femoral curvature
作者:
陈冰峰; 孙立春
(大庆市第五医院,黑龙江 大庆 163714)
Author(s):
CHEN Bingfeng; SUN Lichun
The Fifth Hospital of Daqing City,Daqing 163714,Heilongjiang,China
关键词:
关节成形术; 置换; 膝;  股骨;  畸形;  力线;  机械轴
Keywords:
arthroplasty; replacement; knee;  femur;  malformation;  lines of force;  mechanical axis
摘要:
目的:探讨膝骨关节炎合并股骨侧弓患者全膝关节置换(total knee arthroplasty,TKA)术后下肢机械轴对手术效果的影响。方法:选择2006—2010年在大庆市第五医院接受TKA治疗的74例膝骨关节炎患者(74膝)的病例资料,所有患者术前股骨侧弓角均>5°,术后随访时间均≥60个月。术后下肢机械轴矫正至中立位者34例(中立位组),术后下肢机械轴未矫正至中立位者40例(非中立位组)。比较2组患者的髋-膝-踝(hip-knee-ankle,HKA)角、膝关节主动活动度、Feller髌骨评分、美国膝关节协会(American knee society,AKS)评分及并发症发生情况。结果:①HKA角。术后即刻和末次随访时,中立位组的HKA角均大于非中立位组(178.9°±1.1°,176.1°±1.0°,t=2.779,P=0.008; 178.1°±1.0°,171.9°±1.3°,t=20.395,P=0.000); 中立位组术后即刻与末次随访时的HKA角比较,差异无统计学意义(t=3.919,P=0.752); 非中立位组末次随访时的HKA角较术后即刻时减小(t=2.845,P=0.019)。②膝关节主动活动度。术前及末次随访时,2组患者的膝关节主动活动度比较,组间差异均无统计学意义(105.2°±10.3°,104.7°±10.1°,t=0.208,P=0.836; 121.6°±10.7°,120.8°±10.5°,t=0.714,P=0.477); 与术前相比,末次随访时2组患者的膝关节主动活动度均增大(t=-5.303,P=0.000; t=-6.713,P=0.000)。③Feller髌骨评分。术前及末次随访时,2组患者的Feller髌骨评分比较,组间差异均无统计学意义[(17.3±2.2)分,(16.4±2.1)分,t=1.806,P=0.075;(26.2±1.7)分,(25.7±2.1)分,t=0.899,P=0.371]; 与术前相比,末次随访时2组患者的Feller髌骨评分均增大(t=-21.008,P=0.000; t=-21.562,P=0.000)。④AKS评分。术前及末次随访时,2组患者的AKS评分比较,组间差异均无统计学意义[(60.4±6.5)分,(58.3±7.8)分,t=1.213,P=0.229;(92.7±5.0)分,(90.4±7.3)分,t=1.548,P=0.126]; 与术前相比,末次随访时2组患者的AKS评分均增大(t=-133.158,P=0.000; t=-18.217,P=0.000)。⑤并发症发生情况。2组各有1例患者发生股骨假体周围骨折,均接受手术治疗,术后骨折均愈合良好; 非中立位组2例发生聚乙烯衬垫磨损,最终接受翻修手术。结论:膝骨关节炎合并股骨侧弓患者TKA术后下肢机械轴未矫正至中立位,对膝关节功能恢复无明显影响,但可能导致术后下肢矫正机械轴丢失加快、假体磨损加剧。
Abstract:
Objective:To explore the effects of postoperative mechanical axis of the lower limb(MAL)on the outcomes of total knee arthroplasty(TKA)in patients with knee osteoarthritis(KOA)and lateral femoral curvature.Methods:The medical records of 74 patients(74 knees)who received TKA for KOA in The Fifth Hospital of Daqing City from 2006 to 2010 with the preoperative lateral femoral curvature angle >5 degrees and the postoperative follow-up time≥60 months were selected.After TKA,the MAL was corrected to neutral position in 34 patients(neutral position group),and wasn't in 40 cases(non-neutral position group).The hip-knee-ankle(HKA)angle,active range of motion(ROM)of knee,Feller's patella score,American knee society(AKS)score and postoperative complication incidence were compared between the 2 groups.Results:①The HKA angles were greater in neutral position group compared to non-neutral position group immediately after the TKA and at the last follow-up(178.9±1.1 vs 176.1±1.0 degrees,t=2.779,P=0.008; 178.1±1.0 vs 171.9±1.3 degrees,t=20.395,P=0.000).There was no statistical difference in HKA angles between immediately after the TKA and at the last follow-up in neutral position group(t=3.919,P=0.752),while the HKA angles decreased in non-neutral position group at the last follow-up compared to immediately after the TKA(t=2.845,P=0.019).②There was no statistical difference in the active ROM of knees between the 2 groups before the TKA and at the last follow-up(105.2±10.3 vs 104.7±10.1 degrees,t=0.208,P=0.836; 121.6±10.7 vs 120.8±10.5 degrees,t=0.714,P=0.477).The active ROM of knees increased in the 2 groups at the last follow-up compared to pre-TKA(t=-5.303,P=0.000; t=-6.713,P=0.000).③There was no statistical difference in Feller's patella scores between the 2 groups before the TKA and at the last follow-up(17.3±2.2 vs 16.4±2.1 points,t=1.806,P=0.075; 26.2±1.7 vs 25.7±2.1 points,t=0.899,P=0.371).The Feller's patella scores increased in the 2 groups at the last follow-up compared to pre-TKA(t=-21.008,P=0.000; t=-21.562,P=0.000).④There was no statistical difference in AKS scores between the 2 groups before the TKA and at the last follow-up(60.4±6.5 vs 58.3±7.8 points,t=1.213,P=0.229; 92.7±5.0 vs 90.4±7.3 points,t=1.548,P=0.126).The AKS scores increased in the 2 groups at the last follow-up compared to pre-TKA(t=-133.158,P=0.000; t=-18.217,P=0.000).⑤The periprosthetic femur fracture was found in 1 patient in each group,and the fractures healed well after surgical treatment.Moreover,the wear of polyethylene inserts was found in 2 patients in non-neutral position group,and a revision TKA was performed respectively in the end.Conclusion:An unsuccessful correction of MAL has no significant impact on the recovery of knee function after TKA,while it may accelerate the loss of correction of MAL and aggravate the wear of prosthesis after TKA in patients with KOA and lateral femoral curvature.

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通讯作者:陈冰峰 E-mail:735736092@qq.com
更新日期/Last Update: 1900-01-01