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保留后交叉韧带的全膝关节置换术(110 例膝关节)治疗内翻畸形的中-长期随访结果。

High Medium-Term Survivorship of Cruciate-Retaining Total Knee Arthroplasties (110 Knees) for Valgus Deformity.

机构信息

Department of Orthopaedic Surgery, Wrightington Hospital, Wigan, Apley Bridge, United Kingdom.

出版信息

J Knee Surg. 2021 Mar;34(4):422-426. doi: 10.1055/s-0039-1696956. Epub 2019 Sep 18.

DOI:10.1055/s-0039-1696956
PMID:31533152
Abstract

The main purpose of this article is to evaluate the clinical outcomes and survivorship of cruciate-retaining (CR) knee arthroplasties for valgus deformity. This article is retrospective consecutive series of 110 valgus knees using CR implants with a minimum 2-year follow-up. Deformity correction was achieved using stepwise sequential soft tissue releases (iliotibial band, popliteus tendon, lateral collateral release through sliver femoral condylar osteotomy). Demographic data, range of movement, and degrees of deformity were collected. The Oxford Knee Score (OKS) was used as patients' reported outcome measure at final follow-up. One-hundred and four patients (110 knees) were included (87 females/17 males) with mean age of 68.7 years. Primary diagnosis was osteoarthritis in 85 patients and rheumatoid arthritis in 19 patients. Mean follow-up was 5.5 years (median: 5 years; range: 2-14 years). Preoperative valgus deformity was measured radiographically using the mechanical tibiofemoral angle with a mean 18.6° (standard deviation [SD]: 7.5; range: 11-38°). At final follow-up, mechanical tibiofemoral angle was 3.8° (SD: 1.97; range: 2-8°). A -value was <0.0001 and mean OKS was 42 (SD: 5.4; range: 36-48) suggesting satisfactory patients' reported outcomes with no implant revision for any cause. CR implants for valgus knees using staged soft tissue releases including sliver condylar osteotomy had excellent medium-term survivorship and satisfactory patient reported outcome measures. The Level of Evidence for this study is IV.

摘要

本文的主要目的是评估保留交叉韧带(CR)膝关节置换术治疗外翻畸形的临床结果和存活率。这是一项回顾性连续系列研究,共纳入 110 例使用 CR 植入物的外翻膝,随访时间至少为 2 年。通过逐步连续的软组织松解(髂胫束、腘肌腱、通过股骨髁银质切开松解外侧副韧带)来实现畸形矫正。收集了人口统计学数据、活动范围和畸形程度。在最终随访时,使用牛津膝关节评分(OKS)作为患者的报告结果测量。共纳入 104 例患者(110 膝)(87 例女性/17 例男性),平均年龄为 68.7 岁。原发性诊断为骨关节炎 85 例,类风湿关节炎 19 例。平均随访时间为 5.5 年(中位数:5 年;范围:2-14 年)。术前外翻畸形通过机械胫股角(mean tibiofemoral angle)进行放射测量,平均为 18.6°(标准差[SD]:7.5;范围:11-38°)。最终随访时,机械胫股角为 3.8°(SD:1.97;范围:2-8°)。A 值<0.0001,平均 OKS 为 42(SD:5.4;范围:36-48),提示患者报告的结果令人满意,无任何原因进行植入物翻修。使用分期软组织松解(包括股骨髁银质切开术)的 CR 植入物治疗外翻膝具有极好的中期存活率和令人满意的患者报告结果。本研究的证据水平为 IV 级。

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引用本文的文献

1
The performance of cruciate-retaining implants for primary total knee arthroplasty in valgus deformed knees: A systematic review.外翻畸形膝关节初次全膝关节置换中保留交叉韧带假体的性能:一项系统评价
J Orthop. 2024 Oct 9;61:97-102. doi: 10.1016/j.jor.2024.10.002. eCollection 2025 Mar.
2
Common peroneal nerve palsy after TKA in valgus deformities; a systematic review.外翻畸形全膝关节置换术后腓总神经麻痹;一项系统评价
J Exp Orthop. 2022 Jan 20;9(1):12. doi: 10.1186/s40634-021-00443-x.