Wang Jun-Wen, Wang Ching-Jen
Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan.
J Bone Joint Surg Am. 2002 Oct;84(10):1769-74. doi: 10.2106/00004623-200210000-00005.
Simultaneous corrective osteotomy of angular deformity and total knee arthroplasty has been considered the treatment of choice for patients with arthritis of the knee associated with ipsilateral extra-articular deformity. However, this procedure is technically demanding, and the functional outcome of the total knee arthroplasty may be jeopardized if the osteotomy fails. This retrospective study was performed to evaluate the clinical results of total knee arthroplasty combined with intra-articular bone resection, without osteotomy, in patients with extra-articular deformity and arthritis of the knee.
Fifteen patients with arthritis of the knee and extra-articular deformity underwent total knee arthroplasty with bone resection and soft-tissue balancing. All deformities had resulted from fracture malunion. There were ten uniplanar, three biplanar, and two triplanar deformities. The deformity was in the tibia in eight patients and in the femur in seven. The average angle of the femoral deformities was 15.1 degrees in the coronal plane and 8.1 degrees in the sagittal plane. Two femora had a rotational deformity, consisting of 20 degrees of internal rotation in one and 10 degrees of external rotation in the other. The average angle of the tibial deformities was 19 degrees in the coronal plane.
The duration of follow-up averaged thirty-eight months. The average Knee Society knee score improved from 22.3 points preoperatively to 91.7 points at the time of the last follow-up, and the average Knee Society function score improved from 28.0 points preoperatively to 87.3 points at the time of the last follow-up. The average arc of knee motion improved from 77.7 degrees preoperatively to 103.7 degrees postoperatively. The average mechanical axis of the knee improved from 22.7 degrees of varus preoperatively to 0.3 degrees of varus at the time of the last follow-up. Two patients had an unsatisfactory clinical result, which was not related to the total knee arthroplasty. There were no complications such as infection, ligament instability, or component loosening.
Total knee arthroplasty in conjunction with intra-articular bone resection is an effective procedure for patients with arthritis of the knee and extra-articular varus deformity of <20 degrees in the femur or 30 degrees in the tibia in the coronal plane.
对于伴有同侧关节外畸形的膝关节关节炎患者，同时进行角形畸形矫正截骨术和全膝关节置换术一直被视为首选治疗方法。然而，该手术技术要求较高，如果截骨术失败，全膝关节置换术的功能结果可能会受到影响。本回顾性研究旨在评估在膝关节外畸形和关节炎患者中，不进行截骨术，采用全膝关节置换术联合关节内骨切除的临床效果。
15例膝关节关节炎合并关节外畸形患者接受了全膝关节置换术及骨切除和软组织平衡术。所有畸形均由骨折畸形愈合导致。其中单平面畸形10例，双平面畸形3例，三平面畸形2例。8例患者畸形位于胫骨，7例位于股骨。股骨畸形在冠状面的平均角度为15.1度，矢状面为8.1度。2例股骨存在旋转畸形，其中1例为20度内旋，另1例为10度外旋。胫骨畸形在冠状面的平均角度为19度。
随访时间平均为38个月。膝关节协会膝关节平均评分从术前的22.3分提高到末次随访时的91.7分，膝关节协会功能平均评分从术前的28.0分提高到末次随访时的87.3分。膝关节平均活动弧度从术前的77.7度提高到术后的103.7度。膝关节平均机械轴从术前的内翻22.7度改善到末次随访时的内翻0.3度。2例患者临床结果不满意，但与全膝关节置换术无关。未发生感染、韧带不稳定或假体松动等并发症。
对于膝关节关节炎且股骨冠状面关节外内翻畸形<20度或胫骨冠状面<30度的患者，全膝关节置换术联合关节内骨切除是一种有效的手术方法。
