Takahashi Tsuneari, Matsumura Tomohiro, Takeshita Katsushi
Department of Orthopedic Surgery, Ishibashi General Hospital, Shimotsuke, Japan.
Jichi Medical University Hospital Life Saving Emergency Center, Shimotsuke, Japan.
Trauma Case Rep. 2022 Mar 22;39:100640. doi: 10.1016/j.tcr.2022.100640. eCollection 2022 Jun.
Obtaining alignment during end-stage knee osteoarthritis with extraarticular deformities has always been challenging. Therefore, we report a case of total knee arthroplasty, following the application of Taylor Spatial Frame to treat knee osteoarthritis with severe tibia extraarticular deformity due to a proximal tibia fracture injury for more than 50 years ago. First, proximal tibial opening wedge osteotomy was conducted below the patellar tendon insertion from the anterior to the posterior direction to correct the deformity in multiple planes gradually. Then, osteotomy was done to restore both the varus and recurvatum deformities. Finally, Taylor Spatial Frame was used as a virtual hinge, with gradual adjustments to correct the deformity. Afterward, patient-specific instrumentation-assisted total knee arthroplasty was conducted after correcting the extraarticular deformity. During the two-year follow-up, no superficial and deep infection occurred, and his Oxford Knee Score had improved from 32 to 19 out of 48 at the time of the latest follow-up. Moreover, the patient walked using a one-hand clutch without protective limping. Hence, patient-specific instrumentation-assisted total knee arthroplasty, following proximal tibial osteotomy with Taylor Spatial Frame, should be considered a treatment option for patients with knee osteoarthritis having severe proximal tibia extraarticular deformity.
在患有关节外畸形的终末期膝关节骨关节炎中实现对线一直具有挑战性。因此，我们报告了一例全膝关节置换病例，该病例是在应用泰勒空间框架治疗因50多年前的胫骨近端骨折损伤导致严重胫骨关节外畸形的膝关节骨关节炎之后进行的。首先，在髌腱附着点下方从前向后进行胫骨近端开口楔形截骨，以逐渐纠正多个平面的畸形。然后，进行截骨以恢复内翻和反曲畸形。最后，将泰勒空间框架用作虚拟铰链，逐步调整以纠正畸形。之后，在纠正关节外畸形后进行患者特异性器械辅助全膝关节置换。在两年的随访期间，未发生浅表和深部感染，并且在最近一次随访时，他的牛津膝关节评分从32分提高到了48分中的19分。此外，患者使用单手拐杖行走，无保护性跛行。因此，对于患有严重胫骨近端关节外畸形的膝关节骨关节炎患者，在采用泰勒空间框架进行胫骨近端截骨后进行患者特异性器械辅助全膝关节置换应被视为一种治疗选择。
