Qing Zhong, Ye Jiu-Min, Ma Jian-Bing, Zhi Li-Qiang
Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi, China.
Zhongguo Gu Shang. 2021 Jun 25;34(6):539-43. doi: 10.12200/j.issn.1003-0034.2021.06.012.
In order to observe the clinical effects of sliding osteotomy for patients with severe knee osteoarthritis and varus knee due to complex femoral extra-articular deformity to achieve the medial and lateral soft tissue balancing during total knee arthroplasty.
From June 2014 to January 2018, a total of 22 patients with severe knee osteoarthritis and complex extra-articular malformation of femurs were treated with total knee arthroplasty. There were 5 males and 17 females in this group, aged 48 to 76 years old, with an average age of (61.3±13.8) years old. All the patients had varus deformities caused by extra-articular deformities of femur. Hip-knee-ankle(HKA) angle was(158.8±9.7) ° before operation, and the average Knee Society Score (KSS) clinical score was 32.6±6.1;KSS function score was 35.8 ±9.6;the average Hospital for Special Surgical (HSS) score was 39.7±4.6;the average range of motion before operation was (80.6±10.7) °. The mechanical alignment method was used in joint replacement. The flexion space was balanced first. The coronal plane vertical sliding osteotomy was performed on the medial femoral condyle for the imbalance of coronal plane. The sliding distance of the osteotomy block was determined by straightening the gap between the inner and outer sides of the space until the space was balanced. After the separated segments were fixed with several screws, the prosthesis was installed as usual.
The wounds of all patients healed in the first stage, and no wound complications occurred. All the 22 patients were followed up, and the duration ranged from 18 months to 3 years with an average of (28.2±10.1) months. X-ray showed that the fracture line disappeared for 2 to 5(3.5±1.5) months without nonunion. HKA angle measured at the latest follow up was (178.8±0.7) °, which wassignificantly different from that before operation. The HSS score was 91.3 ±6.0;KSS clinical score 93.7±3.5;KSS functional score 81.2±6.5;and the average range of motion of knee joint was(121.7±11.6) °, which was statistically significant compared with that before operation.
For severe knee osteoarthritis patients with complex femoral extra-articular deformity, sliding osteotomy is performed. For severe varus deformity, downward sliding the medial femoral condyle is performed. The operation is relatively simple and the damage is small. It is easy to achieve the balance of internal and external soft tissue in flexion extension space. The short-term clinical effect is satisfactory.
观察股骨髁上斜行截骨术治疗重度膝关节骨关节炎合并股骨髁间复杂畸形所致膝内翻的临床效果，以实现全膝关节置换术中内外侧软组织平衡。
2014年6月至2018年1月，对22例重度膝关节骨关节炎合并股骨髁间复杂畸形患者行全膝关节置换术。其中男5例，女17例，年龄48～76岁，平均（61.3±13.8）岁。所有患者均因股骨髁间畸形导致膝内翻。术前髋-膝-踝（HKA）角为（158.8±9.7）°，膝关节协会（KSS）临床评分平均为32.6±6.1分；KSS功能评分为35.8±9.6分；特殊外科医院（HSS）评分平均为39.7±4.6分；术前平均活动度为（80.6±10.7）°。关节置换采用机械对线方法。先平衡屈曲间隙。对于冠状面失衡，在股骨内侧髁行冠状面垂直斜行截骨。根据伸直内外侧间隙直至间隙平衡来确定截骨块的滑动距离。分离的骨块用数枚螺钉固定后，按常规安装假体。
所有患者伤口均一期愈合，无伤口并发症发生。22例患者均获随访，随访时间18个月至3年，平均（28.2±10.1）个月。X线显示骨折线在2～5（3.5±1.5）个月消失，无骨不连。末次随访时测量的HKA角为（178.8±0.7）°，与术前相比差异有统计学意义。HSS评分为91.3±6.0分；KSS临床评分为93.7±3.5分；KSS功能评分为81.2±6.5分；膝关节平均活动度为（121.7±11.6）°，与术前相比差异有统计学意义。
对于重度膝关节骨关节炎合并股骨髁间复杂畸形患者，行斜行截骨术。对于重度膝内翻畸形，行股骨内侧髁向下滑动截骨。手术操作相对简单，损伤小。易于实现屈伸间隙内外侧软组织平衡。近期临床效果满意。
