Kawamura Koichiro, Momohara Shigeki, Tomatsu Taisuke
Department of Orthopedic Surgery, Institute of Rheumatology, Tokyo Women's Medical University.
Ryumachi. 2003 Oct;43(4):638-43.
The following is a retrospective study on lower extremity alignment of rheumatoid arthritis (RA) patients with a history of both Total Hip Replacement (THR) and Total Knee Replacement (TKR).
From 1992 to 2000, our department had 26 rheumatoid arthritis patients who underwent both THR and TKR. We classified these patients into three groups based on radiographic alignment of the lower extremities in the standing position: Knock-knee (valgus deformity of the knees), Bowleg (varus deformity of the knees) and Windswept Deformity (one knee in severe varus alignment with the other in severe valgus alignment). Furthermore, we identified dominant weight bearing points of the hip as classified by the following new criteria: Central Shift, Lateral Shift, and Upward Shift. Mal-alignment was then evaluated based on these two classification systems.
Of the 26 patients, 22 patients met our criteria and 4 did not. In mal-alignment, we had 11 cases in the knock-knee group, 5 cases in the bowleg group, and 6 cases in the Windswept deformity. Using the new criteria, central shift had 6 cases; lateral shift had 6 cases; and upward shift had 10 cases. The groups of Lateral shift and Central shift demonstrated deformities of the lower extremities were influenced by moving weight bearing points, pelvis obliquity, and adduction contractures of the hip joint. In upward shift, weight bearing lines did not change. Consequently, destruction of the joint in this group progressed symmetrically. Windswept deformity was asymmetric and had severe destruction on the other side of the knee and forefoot.
Moving of weight bearing point, pelvis obliquity, and adduction contractures of the hip joint affected the severity of mal-alignment of the lower extremities.
以下是一项针对有全髋关节置换（THR）和全膝关节置换（TKR）病史的类风湿关节炎（RA）患者下肢对线情况的回顾性研究。
1992年至2000年，我科有26例类风湿关节炎患者接受了THR和TKR手术。我们根据站立位下肢的影像学对线情况将这些患者分为三组：膝外翻（膝关节外翻畸形）、膝内翻（膝关节内翻畸形）和风吹畸形（一侧膝关节严重内翻，另一侧严重外翻）。此外，我们根据以下新标准确定髋关节的主要负重点：中心移位、外侧移位和向上移位。然后根据这两种分类系统评估对线不良情况。
26例患者中，22例符合我们的标准，4例不符合。在对线不良方面，膝外翻组有11例，膝内翻组有5例，风吹畸形组有6例。采用新标准，中心移位有6例；外侧移位有6例；向上移位有10例。外侧移位组和中心移位组显示下肢畸形受负重点移动、骨盆倾斜和髋关节内收挛缩影响。在向上移位组中，负重线未改变。因此，该组关节破坏呈对称进展。风吹畸形不对称，膝关节和前足另一侧有严重破坏。
负重点移动、骨盆倾斜和髋关节内收挛缩影响下肢对线不良的严重程度。
