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外翻畸形角度大于90°的全膝关节置换术:一例报告。

Total knee arthroplasty for a valgus deformity angle of >90°: A case report.

作者信息

Guo Jianbin, Cao Guihua, Zhang Yumin, Song Wei, Qin Siqing, Ma Tao, Wang Yakang, Yang Weixia

机构信息

Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University.

Institute of Geriatrics, Xijing Hospital, The Air Force Medical University.

出版信息

Medicine (Baltimore). 2019 Jun;98(23):e15745. doi: 10.1097/MD.0000000000015745.

Abstract

RATIONALE

Valgus knees are relatively rare in the clinic. Treatments for valgus deviations >90° represent a surgical challenge to achieve a balance between the soft tissue and bone and prevent nerve damage.

PATIENT CONCERNS

A 63-year-old woman with valgus deviations >90° in both knees complained that she had been unable to walk for 50 years.

DIAGNOSES

Congenital malformation valgus deformity.

INTERVENTIONS

Bilateral total knee arthroplasty (TKA) was performed using a rotating hinge knee instrument from Endo-Model for axial correction and stabilization of the joint.

OUTCOMES

The patient fully recovered 3 months after surgery. At the follow-up 6 years after the operation, the function of the knee joint clearly improved. The knee society score (KSS) increased from 35 to 90.

LESSONS

Constrained implants are commonly used to stabilize the joint and correct the bone axis in patients with severe ligamental instability, gross deformity, bone loss, and extreme deviation of the straight leg axis. Intraoperative exploration of the common peroneal nerve and the postoperative flexed position of the knee joints could help prevent nerve injuries.

摘要

理论依据

膝外翻在临床上相对少见。对于外翻角度大于90°的治疗,要在软组织和骨骼之间实现平衡并防止神经损伤,这对手术来说是一项挑战。

患者情况

一名63岁女性,双膝外翻角度均大于90°,主诉已无法行走50年。

诊断

先天性畸形性膝外翻。

干预措施

使用Endo-Model公司的旋转铰链膝关节器械进行双侧全膝关节置换术(TKA),以实现关节的轴向矫正和稳定。

结果

患者术后3个月完全康复。术后6年随访时,膝关节功能明显改善。膝关节协会评分(KSS)从35分提高到90分。

经验教训

对于存在严重韧带不稳定、严重畸形、骨质流失和直腿轴线极度偏差的患者,通常使用限制性植入物来稳定关节并矫正骨轴线。术中探查腓总神经以及术后膝关节处于屈曲位有助于预防神经损伤。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/27f1/6571272/d2e2f612bcc9/medi-98-e15745-g001.jpg

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