不同程度膝内翻患者初次全膝关节置换术后下肢力线分布与近期临床疗效的关系
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作者Author单位AddressE-Mail
刘磊 LIU Lei 徐州医科大学附属医院骨科, 江苏 徐州 221002  
徐石庄 XU Shi-zhuang 徐州医科大学附属医院骨科, 江苏 徐州 221002  
杨冠杰 YANG Guan-jie 徐州医科大学附属医院骨科, 江苏 徐州 221002  
郑力 ZHENG Li 徐州医科大学附属医院骨科, 江苏 徐州 221002  
李大地 LI Da-di 徐州医科大学附属医院骨科, 江苏 徐州 221002  
郭开今 GUO Kai-jin 徐州医科大学附属医院骨科, 江苏 徐州 221002  
赵凤朝 ZHAO Feng-chao 徐州医科大学, 江苏 徐州 221004 Xuzhou Medical University, Xuzhou 221004, Jiangsu, China zhjianzh@vip.sina.com 
期刊信息:《中国骨伤》2020年,第33卷,第6期,第530-535页
DOI:10.12200/j.issn.1003-0034.2020.06.008
基金项目:
中文摘要:

目的:探讨不同程度膝内翻畸形患者行初次全膝关节置换术后下肢力线分布与近期临床疗效之间的关系。

方法:自2016年12月至2018年3月行初次全膝关节置换术治疗的膝骨性关节炎患者87例(101膝),男21例(25膝),女66例(76膝);年龄51~85(67.6±7.0)岁。根据患者全膝关节置换术后下肢髋膝踝角(hip-knee-ankle angle,HKA)不同分为4组:中立位组(A组),-3°≤HKA≤3°,50膝;轻度内翻组(B组),3° < HKA < 6°,20膝;严重内翻组(C组),HKA≥6°,20膝;外翻组(D组),HKA<-3°,11膝。比较4组患者术前性别、年龄、体质量指数、手术侧别、术前及术后膝关节活动度,美国特种外科医院膝关节评分(Hospital for Special Surgery Knee Score,HSS),美国膝关节协会评分(Knee Social Score,KSS),并分别比较术后股骨、胫骨假体力线分布与近期临床疗效的关系。

结果:所有病例获得随访,时间(18.4±4.0)个月。4组患者术后末次随访膝关节活动度、HSS、KSS评分均较术前提高(P<0.001)。4组患者术后末次随访HSS、KSS评分组间比较差异具有统计学意义(P<0.05);A组评分优于C、D两组(P<0.05),B组评分优于C、D两组(P<0.05),A、B两组间以及C、D两组间比较差异无统计学意义(P>0.05);4组患者术后膝关节活动度组间比较差异无统计学意义。股骨假体力线在±3°以内组评分优于3°以外组(P<0.05),胫骨假体力线在±3°以内组评分较3°以外组差异无统计学意义(P>0.05)。

结论:膝内翻型骨关节炎患者初次全膝关节置换术后近期临床疗效与下肢力线分布有关,力线轻度内翻位分布可获得与中立位相似的近期临床疗效,股骨假体力线分布与初次膝关节置换术后近期临床疗效有关。
【关键词】膝关节  全膝关节置换术  下肢  膝内翻
 
Relationship between lower limb alignment distribution and short-term clinical results after primary total knee arthroplasty in patients with varying degrees of knee varus
ABSTRACT  

Objective: To analyze the relationship between the distribution of lower limb alignment and short-term clinical efficacy in patients with varus-type osteoarthritis after primary total knee arthroplasty (TKA).

Methods: From December 2016 to March 2018,87 patients(101 knees) with knee osteoarthritis were treated with the first total knee arthroplasty by the same medical group,including 21 males(25 knees) and 66 females(76 knees),ranging in age from 51 to 85 years old,with a mean of (67.6±7.0) years old. According to the difference of hip knee ankle angle (HKA) after total knee arthroplasty,the patients were divided into 4 groups:neutral position group (group A),-3° ≤ HKA ≤ 3°,50 knees;slight varus group (group B),3° < HKA < 6°,20 knees;severe varus group (group C),HKA ≥ 6°,20 knees;valgus group (group D),HKA < -3°,11 knees. The preoperative sex,age,body mass index,operative side,preoperative and postoperative knee joint activity,HSS score,KSS clinical and functional score were compared among the 4 groups,and the relationship between the force line distribution of femoral and tibial prosthesis and the recent clinical effect was compared.

Results: All the patients were followed up with a mean duration of(18.4±4.0) months. The range of motion of knee joint,HSS and KSS scores at the latest follow-up after operation in the 4 groups were higher than those before operation,and the difference was statistically significant (P<0.001). There were significant differences in HSS and KSS scores among the 4 groups at the latest follow-up (P<0.05);and the results in group A were better than those in group C and group D(P<0.05);the results in group B were better than those in group C and group D(P<0.05);there was no significant difference between group A and group B or group C and group D(P>0.05). There was no significant difference in knee joint activity among the 4 groups. The score of femoral prosthesis force line within ±3°was better than that of the other group(P<0.05),and the score of tibia prosthesis force line had no significant difference between within ±3°group and other group(P>0.05).

Conclusion: The short-term clinical efficacy of patients with knee varus osteoarthritis after primary total knee arthroplasty is related to the distribution of lower limbs alignment. The short-term clinical efficacy of slight inversion position can be similar to that of neutral position. The force line distribution of femoral prosthesis is related to the short-term clinical efficacy after primary knee arthroplasty.
KEY WORDS  Knee joint  Total knee arthroplasty  Lower extremity  Genu varum
 
引用本文,请按以下格式著录参考文献:
中文格式:刘磊,徐石庄,杨冠杰,郑力,李大地,郭开今,赵凤朝.不同程度膝内翻患者初次全膝关节置换术后下肢力线分布与近期临床疗效的关系[J].中国骨伤,2020,33(6):530~535
英文格式:LIU Lei,XU Shi-zhuang,YANG Guan-jie,ZHENG Li,LI Da-di,GUO Kai-jin,ZHAO Feng-chao.Relationship between lower limb alignment distribution and short-term clinical results after primary total knee arthroplasty in patients with varying degrees of knee varus[J].zhongguo gu shang / China J Orthop Trauma ,2020,33(6):530~535
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