全膝关节置换术与关节外畸形：通过关节内截骨矫正畸形。10年随访
Total knee arthroplasty and extra-articular deformity: Deformity correction with intra-articular bone resections. 10 years follow up.
作者信息
Vedoya Santiago P, Sel Hernán Del
机构信息
Hospital Británico de Buenos Aires, Orthopaedic Department, Buenos Aires, Argentina.
出版信息
J Orthop. 2021 Jan 30;23:219-224. doi: 10.1016/j.jor.2021.01.007. eCollection 2021 Jan-Feb.
BACKGROUND
This study aimed to evaluate the feasibility and clinical results of one stage total knee arthroplasty for patients with knee osteoarthritis with extra-articular femoral or tibial deformity, treated with intra-articular bone resections and soft tissue balance for deformity correction.
METHODS
28 patients (29 knees) with osteoarthritis of the knee associated with extra-articular deformity >10° underwent one-stage total knee arthroplasty from 1997 to 2017. The deformity was corrected in all the patients by mean off the intra-articular bone resections and soft tissue release during the knee arthroplasty. 14 of them had tibial deformities, 15 had femoral deformities, and the etiology was post traumatic in 14 cases and post osteotomy in 15. The Knee Society Score was used to evaluate the patient outcome.
RESULTS
One-stage total knee arthroplasty with intra-articular correction of the limbs extra-articular deformity and soft tissue releases to balance the knee in flexion and extension was performed in all the patients.The average follow up was of 10.3 years. The average Knee Society Score was of 24.3 points preoperatively and 86 points at one year after surgery. The range of motion improved from 83.7° preoperatively to 107.1° (86°-125°) postoperatively. The average mechanical axis deviation was restored from 11.8° preoperatively to 0.9° postoperatively, and the postoperative average anatomical axis was 6.3°. Two prosthesis were revised, one due to deep infection and one because knee instability.
CONCLUSION
The correction of the extra-articular deformity by intra-articular bone resections performed at the time of a total knee arthroplasty is indicated if the resections do not affect the femoral or tibial insertions of the collateral ligaments of the knee, and is the treatment option to avoid performing an osteotomy to correct de limb axis. This method can be applied to angular deformities up to 20° in the femur and up to 30° in the tibia. Through this technique we have achieved good results, after more than 10 years of follow up, in 27 of the 29 patients treated.This is a retrospective level 2 study.
背景
本研究旨在评估一期全膝关节置换术治疗合并关节外股骨或胫骨畸形的膝骨关节炎患者的可行性及临床效果，通过关节内截骨和软组织平衡来矫正畸形。
方法
1997年至2017年，28例（29膝）合并>10°关节外畸形的膝骨关节炎患者接受了一期全膝关节置换术。所有患者均在膝关节置换术中通过关节内截骨和软组织松解矫正畸形。其中14例有胫骨畸形，15例有股骨畸形，病因创伤后14例，截骨术后15例。采用膝关节协会评分评估患者预后。
结果
所有患者均接受了一期全膝关节置换术，通过关节内矫正肢体关节外畸形和软组织松解来平衡膝关节屈伸。平均随访10.3年。术前膝关节协会平均评分为24.3分，术后1年为86分。活动范围从术前的83.7°改善至术后的107.1°（86°-125°）。平均机械轴偏差从术前的11.8°恢复至术后的0.9°，术后平均解剖轴为6.3°。2例假体翻修，1例因深部感染，1例因膝关节不稳。
结论
如果截骨不影响膝关节侧副韧带的股骨或胫骨附着点，则在全膝关节置换时通过关节内截骨矫正关节外畸形是可行的，是避免行截骨术矫正肢体轴线的治疗选择。该方法可应用于股骨高达20°、胫骨高达30°的角状畸形。通过该技术，在29例接受治疗的患者中，27例经过10多年随访取得了良好效果。这是一项回顾性2级研究。
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