目的:探讨个性化截骨在重度内翻膝骨关节炎初次全膝关节置换术(TKA)中的应用价值及疗效。
方法:从2018年6月至2020年1月,治疗36例(49膝)严重内翻膝骨关节炎患者,包括15名男性(21膝)和21名女性(28膝),年龄59~82岁,平均(67.6±6.5)岁,病程9.5~20.5年,平均(15.0±5.0)年,Kellgren-LawrenceⅢ级11例(15膝),Kellgren-LawrenceⅣ级25例(34膝)。根据AORI骨化的胫骨骨缺损,Ⅰ型Ta8例(15膝),Ⅱ型T2a16例(18膝)。所有患者股胫骨角(FTA)均大于15°,并接受了原发性TKA和个性化截骨术。33例患者(45膝)接受了后稳定型(PS)假体治疗,13名患者(15个膝盖)在胫骨侧使用PS假体结合金属垫和延长杆,和3例患者(4个膝盖)使用传统的髁突膝关节(LCCK)假体。FTA,后髁角(PCA),使用图片存档和通信系统(PACS)测量并比较手术前后1个月的胫骨内侧近端角(MPTA)和股骨外侧远端角(LDFA)。术后12个月采用美国膝关节协会评分(KSS)评价下肢恢复情况,观察并记录并发症。
结果:36例(49膝)均获随访,随访时间15~40个月,平均(23.46±7.65)个月。FTA,术后1个月MPTA由术前(18.65±4.28)°和(83.75±3.65)°校正至术后(2.35±1.46)°和(88.85±2.25)°,分别(P<0.001)。术后1个月PCA从术前(2.42±2.16)°下降至(1.65±1.35)°,LDFA由术前的(89.56±3.55)°改善至术后1个月的(91.63±3.38)°(P<0.05)。KSS从术前的(67.58±24.16)增加到术后12个月的(171.31±15.24),14例患者(19膝)获得了优异的结果,19(26膝盖)好,和3(4膝盖)公平。
结论:个性化截骨有助于下肢轴向对位的恢复和假体的正确放置,能有效缓解膝关节疼痛,恢复膝关节功能。
OBJECTIVE: To explore application value and efficacy of personalized osteotomy in primary total knee arthroplasty (TKA) for severe varus knee osteoarthritis.
METHODS: From June 2018 to January 2020, 36 patients (49 knees) with severe varus knee osteoarthritis were treated, including 15 males (21 knees) and 21 females (28 knees), aged from 59 to 82 years old with an average of (67.6 ± 6.5) years old;the course of disease ranged from 9.5 to 20.5 years with an average of (15.0 ± 5.0) years;11 patients (15 knees) with Kellgren-Lawrence grade Ⅲ and 25 patients (34 knees) with grade Ⅳ according to Kellgren-Lawrence grading. According to AORI clsssification of tibial bone defects, 8 patients (15 knees) were typeⅠTa and 16 patients (18 knees) were typeⅡ T2a. All patients\' femor-tibial angle (FTA) was above 15°, and received primary TKA with personalized osteotomy. Thirty-three patients (45 knees) were treated with posterior-stabilized (PS) prostheses, 13 patients (15 knees) with PS prostheses combined with a metal pad and extension rod on the tibial side, and 3 patients (4 knees) with legacy constrained condylar knee (LCCK) prostheses. FTA, posterior condylar angle (PCA), medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA) before and after operation at 1 month were measured and compared by using picture archiving and communication systems (PACS). Recovery of lower limbs before and after operation at 12 months was evaluated by American Knee Society Score(KSS), and complications were observed and recorded.
RESULTS: All 36 patients (49 knees) were followed up from 15 to 40 months with an average of (23.46±7.65) months. FTA, MPTA were corrected from preoperative (18.65±4.28)° and (83.75±3.65)° to postoperative (2.35±1.46)° and (88.85±2.25)° at 1 month, respectively (P<0.001). PCA was decreased from (2.42±2.16)° before operation to (1.65±1.35)° at 1 month after operation, LDFA improved from (89.56 ± 3.55)° before operation to (91.63±3.38)° at 1 month after operation (P<0.05). KSS increased from (67.58±24.16) before opertion to(171.31±15.24) at 12 months after operation, 14 patients (19 knees) got excellent result, 19 (26 knees) good, and 3 (4 knees) fair.
CONCLUSIONS: Personalized osteotomy is helpful for recovery of axial alignment of lower limbs and correct placement of prosthesis, could effectively relieve pain of knee joint, recover knee joint function.