Li Guoliang, Han Guangpu, Zhang Jinxiu, Ma Shiqiang, Guo Donghui, Yuan Fulu, Qi Bingbing, Shen Runbin
Department of Orthopedics, Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Cangzhou Hebei, 061001, P.R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013 Jul;27(7):847-50.
To explore the application value of self-made tibial mechanical axis locator in tibial extra-articular deformity in total knee arthroplasty (TKA) for improving the lower extremity force line.
Between January and August 2012, 13 cases (21 knees) of osteoarthritis with tibial extra-articular deformity were treated, including 5 males (8 knees) and 8 females (13 knees) with an average age of 66.5 years (range, 58-78 years). The disease duration was 2-5 years (mean, 3.5 years). The knee society score (KSS) was 45.5 +/- 15.5. Extra-articular deformities included 1 case of knee valgus (2 knees) and 12 cases of knee varus (19 knees). Preoperative full-length X-ray films of lower extremities showed 10-21 degrees valgus or varus deformity of tibial extra joint. Self-made tibial mechanical axis locator was used to determine and mark coronal tibial mechanical axis under X-ray before TKA, and then osteotomy was performed with extramedullary positioning device according to the mechanical axis marker.'
All incisions healed by first intention, without related complications of infection and joint instability. All patients were followed up 5-12 months (mean, 8.3 months). The X-ray examination showed < 2 degrees knee deviation angle in the others except 1 case of 2.9 degrees knee deviation angle at 3 days after operation, and the accurate rate was 95.2%. No loosening or instability of prosthesis occurred during follow-up. KSS score was 85.5 +/- 15.0 at last follow-up, showing significant difference when compared with preoperative score (t=12.82, P=0.00).
The seft-made tibial mechanical axis locator can improve the accurate rate of the lower extremity force line in TKA for tibia extra-articular deformity.
探讨自制胫骨机械轴定位器在全膝关节置换术（TKA）治疗胫骨关节外畸形中改善下肢力线的应用价值。
2012年1月至8月，治疗13例（21膝）伴有胫骨关节外畸形的骨关节炎患者，其中男性5例（8膝），女性8例（13膝），平均年龄66.5岁（范围58 - 78岁）。病程2 - 5年（平均3.5年）。膝关节协会评分（KSS）为45.5±15.5。关节外畸形包括膝外翻1例（2膝），膝内翻12例（19膝）。术前下肢全长X线片显示胫骨关节外10 - 21度的内翻或外翻畸形。在TKA术前，使用自制胫骨机械轴定位器在X线下确定并标记胫骨冠状面机械轴，然后根据机械轴标记用髓外定位装置进行截骨。
所有切口均一期愈合，无感染及关节不稳定等相关并发症。所有患者均获随访5 - 12个月（平均8.3个月）。X线检查显示，除1例术后3天膝关节偏差角为2.9度外，其余患者膝关节偏差角均<2度，准确率为95.2%。随访期间未发生假体松动或不稳定。末次随访时KSS评分为85.5±15.0，与术前评分比较差异有统计学意义（t = 12.82，P = 0.00）。
自制胫骨机械轴定位器可提高TKA治疗胫骨关节外畸形时下肢力线的准确率。
