合并膝内翻骨性关节炎全膝关节置换的处理

目的探讨膝骨性关节炎合并膝内翻畸形者行膝关节置换时膝内翻的矫正方法。方法172例（190膝）合并内翻畸形骨性关节炎患者进行全膝关节表面置换术。术前测量膝内翻角、关节面夹角、胫骨角、胫骨内翻角及胫骨平台后倾角,其内翻角为8°～21°,参考关节面夹角、胫骨角及胫骨内翻角确定膝内翻的类型,术中根据膝内翻的类型及构成因素进行相应的胫骨截骨及适度的软组织松解。结果出现切口感染2例（2膝）,1例为急性感染,1例为迟发性感染,2例均经清创、假体取出并膝关节融合术后痊愈。术后内翻矫正157膝,仍有膝内翻33膝,内翻角3°～9°（4.8°±0.9°）。165例（182膝）获得随访,时间8～90（40±3.5）个月。末次随访时除2例感染外,余膝关节活动度为：伸直0°168膝,伸直受限＆lt;10°11膝,伸直受限11°～15°3膝;屈曲90°～130°。临床及X线检查未见明显松动迹象。HSS膝关节评分由术前12～57（30±5.5）分提高到76～89（79.2±4.3）分。结论术前明确膝内翻的类型及构成因素,术中采取针对性操作进行适度的软组织松解及正确的截骨,是全膝关节置换膝内翻获得矫正的有效方法。

Management with total knee arthroplasty for knee arthrositis with varus

Objective To explore the correction methods of knee arthrositis with varus by total knee arthroplasty.Methods 172 cases（190 knee） of knee arthrositis with varus were been treated by total knee arthroplasty.The varus angle,angle of articular surface,tibial angle,varus angle of tibial and posterior tilt angle of tibial platform were measured preoperatively.The varus angle was from 8° to 21°.Reciprocal osteotomy of tibia and moderate relax of soft tissue were manipulated during operation.Results 2 cases got infection,of which one was acute infection,the other was late onset.The 2 cases got healing by debridement,prosthesis removing and knee joint fusing.Knee varus in 157 knees was corrected,while 33 knees remained varus postoperatively.All cases except 7 cases were followed up for 8～90（40±3.5）months.Except 2 infective cases,168 knees got 0°extension,11 got〈 10°extension,and 3 got 11°～15°extension.All got 90°～130°flexion.The HSS scores were improved from 12～57（30±5.5） to 76～89（79.2±4.3）.There was no evidence of loosening at clinical and X-ray.Conclusions Identify type of knee varus and composition factor preoperatively,precise osteotomy of tibia and moderate relax of soft tissue are effective methods of correction of knee varus.