周　卫　徐振伟　马国涛　吴登科　赵世阳河南省平顶山市第一人民医院关节骨病科，河南平顶山　467000

全膝关节置换治疗膝关节外翻畸形的临床分析

周卫徐振伟马国涛吴登科赵世阳
河南省平顶山市第一人民医院关节骨病科，河南平顶山467000

目的 观察全膝关节置换（TKA）治疗膝关节外翻畸形的临床效果。方法回顾性分析2010年10月～2014年10月采用TKA治疗膝关节外翻畸形患者27例（32膝）的临床资料，其中男6例，6膝关节，女21例，26膝关节，年龄31～72岁，平均68.7岁，进行临床效果评价。结果 置换后随访12～48个月，术后切口均一期愈合，无感染，无腓总神经麻痹发生，患者膝关节活动范围术前50°～105°，平均（68.50±17.56）°,术后90°～125°，平均（108.50± 26.78）°，股胫角术前11°～31°，平均（18.2±5.1）°，术后3°～11°，平均（8.5±2.1）°，美国特种外科医院膝关节评分（HSS）术前28～54分，平均（39.0±4.57）分，术后45～100分，平均（88.2±15.8）分，两组比较差异有统计学意义（P＜0．05）。结论 膝关节外翻畸形可采用常规截骨、单纯外侧软组织松解及后稳定型假体植入，能较好地矫正外翻畸形，近期疗效满意。

膝关节外翻；全膝关节置换术；外侧软组织松解；HSS评分

[Abstract]Objective To observe clinicaI effects of totaI knee arthroplasty(TKA)for valgus knee deformity．Methods Clinical data of 27 cases of valgus knee deformity(32 knees)undergoing total knee arthroplasty were retrospectively analyzed from October 2010 to October 2014．There were 6 males(6 knees)and 21 females(26 knees)，at the age from 31 to 72 years，with an average age of 68．7 years．Clinical efects of total knee arthroplasty were evaluated.Results The postoperative follow-up lasted from 12 to 48 months．All cuts had healed，no infection，and no peroneal nerve paralysis. Joint range of motion were rectified from preoperatively(68.5±17.6)°(range,50°-105°)to preoperatively（108．5±26.8）° (range,90°-125°)on average.Femorotibial angle were rectified from preoperatively（18.2±5.1）°(range,11°-31°)to postoperatively(8.5±2.1)°(range,3°-11°).Hospital for Special Surgery knee score(HSS)were rectified from preoperatively 39.0±4.57(range,28-54)39.0 to postoperatively 88.2±15.8(range,45-100)(P<0.05).Conclusion The techniques of standard osteotomy and only lateral soft tissue release with posterior stabilized implants can deal with a valgus knee deformity very successfully in patients undergoing primary total knee arthroplasty，and provide excellent results．

[Key words]Knee valgus;Total knee arthrophasty;Lateral soft tissue release;HSS score

全膝关节置换术（TKA）治疗膝关节疾患已经很普及，患者多伴随内翻畸形，少部分患者伴随外翻畸形，膝外翻畸形常见于类风湿关节炎，骨性关节炎，外侧髁发育不良，既往创伤史，曾经有过改变下肢承重力线手术史，常发生胫骨外旋畸形，由于股骨外侧髁于胫骨后面相关节，外翻畸形常见胫骨后外侧缺损，股骨外侧髁常发育不良，常合并外侧支持带挛缩，TKA手术难度大，需松解外侧支持结构，外侧关节囊，腘肌腱等结构，术中精确的韧带平衡技术是保证术后假体的稳定性、寿命和良好功能的关键[1，2]。……