Fan Jason Ch, Kwok K B, Hung Y W
1 Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, Hong Kong Sar.
J Orthop Surg (Hong Kong). 2018 Jan-Apr;26(1):2309499017718911. doi: 10.1177/2309499017718911.
By analyzing a case of total knee arthroplasty (TKA) in a knee with complex deformity and secondary osteoarthritis, we demonstrated the rationale of preoperative planning and the detail of intraoperative execution. The lady had right TKA with combined medial closing wedge femoral osteotomy, neutral wedge valgus derotational tibial osteotomy, fibular osteotomy, and quadriceplasty. Four months later, she had left TKA. Osteotomies healed well and she was pain-free at 18 months after right TKA. Combination of intra-articular and extra-articular correction of deformity was the key to achieve a well-aligned TKA with good soft tissue balancing in both coronal and sagittal planes. The choice of osteotomy fixation method should follow the principles of bone healing. Fibular osteotomy should have been made at the level of tibial osteotomy with caution. Use of appropriate TKA prosthesis could have enhanced the osteotomy fixation while decreasing the complication.
通过分析一例膝关节复杂畸形并继发骨关节炎患者的全膝关节置换术（TKA），我们阐述了术前规划的基本原理及术中操作细节。该女性患者接受了右侧TKA手术，同时进行了内侧闭合楔形股骨截骨术、中立楔形外翻旋转胫骨截骨术、腓骨截骨术及股四头肌成形术。四个月后，她接受了左侧TKA手术。截骨愈合良好，右侧TKA术后18个月时她已无疼痛。关节内和关节外畸形矫正相结合是在冠状面和矢状面实现良好对线的TKA及良好软组织平衡的关键。截骨固定方法的选择应遵循骨愈合原则。腓骨截骨应谨慎地在胫骨截骨水平进行。使用合适的TKA假体可增强截骨固定效果并减少并发症。
