Yu Changchun, Wang Zhanchao, Shang Yanchun
Department of Knee Joint, Luoyang Hospital of Orthopedics and Traumatics, Luoyang Henan 471002, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2007 Oct;21(10):1062-6.
To explore the technique of the soft tissue balancing in the total knee arthroplasty (TKA) for the patients with the knees of varus deformity and flexion contracture.
From January 2001 to December 2005, 86 patients (19 males, 67 females; age, 57-78 years; average, 66 years) with the knees of varus deformity and flexion contracture underwent primary TKA and the balancing of the soft tissues. All the patients had suffered from osteoarthritis. The unibilateral affection was found in 68 patients and the bilateral affection in 18. The varus deformity angle was averaged 12.3 degrees (range, 6-34 degrees). The soft tissue varus accounted for 56.7% and the bony varus accounted for 43.3%. The flexion contracture < 10 degrees was found in 21 knees, 10-19 degrees in 45 knees, 20-29 degrees in 22 knees, and > 30 degrees in 16 knees, with an average angle of 18.9 degrees.
The flexion contractures were improved. Before operation the average angle of the flexion contracture was 18.9 degrees but after operation only 4 patients had a residual flexion contracture of 5 degrees and the remaining patients had a complete correction. The follow-up for 37 months (range, 6-72 months) in all the patients revealed that only 6 patients had a residual flexion contracture of 5-10 degrees and the others had a full extension. Before operation the average varus angle was 12.3 degrees (range, 6-34 degrees) and the average tibiofemoral angle was 174.7 degrees (range, 170.3-175.6 degrees), but after operation the residual varus angle > 3 degrees was only found in 2 patients. The complications occurring during operation and after operation were found in 6 patients, injuries to the attachment of the medial collateral ligaments in 2, patellar clunk syndromes in 2, cerebral embolism in 1, and lacunar infarction in 1, with no nerve disorders left after the medical treatment. No skin necrosis, the cut edge infection or deep infection occurred.
The balancing of the soft tissues is a major management for correction of the varus deformity and the flexion contracture. The proper balancing of the soft tissues can achieve an obvious recovery of the function and correction of the varus deformity after TKA.
探讨针对膝内翻畸形合并屈曲挛缩患者进行全膝关节置换术（TKA）时的软组织平衡技术。
2001年1月至2005年12月，86例膝内翻畸形合并屈曲挛缩患者（男19例，女67例；年龄57 - 78岁，平均66岁）接受了初次TKA及软组织平衡手术。所有患者均患有骨关节炎。单侧患病68例，双侧患病18例。膝内翻畸形角度平均为12.3度（范围6 - 34度）。软组织性膝内翻占56.7%，骨性膝内翻占43.3%。21例膝关节屈曲挛缩<10度，45例为10 - 19度，22例为20 - 29度，16例>30度，平均角度为18.9度。
屈曲挛缩得到改善。术前屈曲挛缩平均角度为18.9度，术后仅4例残留5度屈曲挛缩，其余患者均完全矫正。所有患者随访37个月（范围6 - 72个月），仅6例残留5 - 10度屈曲挛缩，其余患者均能完全伸直。术前平均内翻角度为12.3度（范围6 - 34度），平均胫股角为174.7度（范围170.3 - 175.6度），术后仅2例残留内翻角度>3度。手术中和术后出现并发症6例，其中内侧副韧带附着点损伤2例，髌骨关节卡顿综合征2例，脑栓塞1例，腔隙性脑梗死1例，经治疗后无神经功能障碍。未发生皮肤坏死、切口感染或深部感染。
软组织平衡是矫正膝内翻畸形和屈曲挛缩的主要措施。适当的软组织平衡可使TKA术后功能明显恢复，膝内翻畸形得到矫正。
