严重膝外翻的TKA比较研究.docVIP

Total knee arthroplasty in severe valgus knee deformity:comparison of a standard medial parapatellar approach combined with tibial tubercle osteotomy 严重膝外翻畸形的全膝关节置换：标准内侧髌旁入路联合胫骨结节截骨的对照研究 Abstract Purpose Primary TKA in valgus knees with a deformity of more than ten degrees may prove challenging, since bone and soft tissue abnormalities make accurate axis restoration, component orientation and joint stability attainment a dif?cult task. The purpose of this study was to determine which approach is optimal in these patients, by comparing the standard medial parapatellar approach to a lateral parapatellar combined with a tibial tubercle osteotomy (TTO). 摘要 目的 对于超过10度膝外翻畸形的一期全膝关节置换是具有挑战性的，因为骨与软组织的异常使得轴线的精确重建、假体部件的定位及关节稳定性的保留非常困难。本研究通过比较标准内侧髌旁入路与外侧髌旁入路联合胫骨结节截骨（TTO）两种入路，确定哪一种入路对这些病人是最理想的。 Methods Forty-four valgus knees—with an axis deviation ranging from 15 to 36 degrees (mean 24)—were dealt with primary TKA and followed up for a minimum period of 7 years. Lateral parapatellar arthrotomy combined with TTO was performed in 22 individuals (Group A) and a standard medial parapatellar capsulotomy in the remaining patients (Group B). The International Knee Society System Score (IKSS) was used for clinical evaluation. Radiological assessment was performed yearly postoperatively using long ?lms for assessment of the anatomical axis. 方法 44例膝外翻病人，轴线偏移范围在15-36度（平均24度），均行一期TKA，术后进行至少7年的随访。22例患者（A组）行外侧髌旁关节切开联合TTO入路，余下的患者（B组）行标准内侧髌旁关节切开入路。使用国际膝关节协会系统评分（IKSS）进行临床评估。术后每年进行放射学评估，使用长胶片进行解剖轴线评估。 Results The postoperative IKSS scores showed no signi?cant statistical difference between groups A and B (P\0.05). In the alignment parameter, however, residual valgus deviation occurred in 9% of patients from Group A and in 32% from Group B. No late-onset instability was displayed. 结果 A、B两组术后IKSS评分无明显统计学差异（P0.05）。然而，在对线参数方面，A组病人仅有9%残余外翻畸形，而B组有32%。没有发现有迟发性不稳。 Conclusion Lateral parapatellar approach combined with TTO may prove highly bene?cial in signi?cant valgus deformities, as the anatomical