• 中國醫(yī)學(xué)科學(xué)院 北京協(xié)和醫(yī)學(xué)院北京協(xié)和醫(yī)院骨科（北京，100730）;

目的 探討對終末期膝關(guān)節(jié)病變合并膝外翻畸形患者行經(jīng)髕旁內(nèi)側(cè)入路人工全膝關(guān)節(jié)置換（total knee arthroplasty，TKA）時膝外翻畸形矯正方法及臨床療效。 方法 1998 年11 月－ 2010 年10 月，收治64 例72 膝合并膝外翻畸形的終末期膝關(guān)節(jié)病變患者。男18 例，女46 例；年齡23 ～ 82 歲，平均62.5 歲。骨關(guān)節(jié)炎44 例49 膝，類風(fēng)濕性關(guān)節(jié)炎17 例20 膝，血友病性關(guān)節(jié)炎2 例2 膝，創(chuàng)傷性關(guān)節(jié)炎1 例1 膝。雙膝8 例，單膝56 例。膝關(guān)節(jié)屈伸活動度為（82.2 ± 28.7）°，X 線片測量股脛角為（18.0 ± 5.8）°。膝關(guān)節(jié)學(xué)會評分系統(tǒng)（KSS）臨床評分為（31.2 ± 10.1）分，功能評分（37.3 ± 9.0）分。根據(jù)Krackow 膝外翻分型標(biāo)準(zhǔn)：Ⅰ型65 膝，Ⅱ型7 膝。手術(shù)經(jīng)髕旁內(nèi)側(cè)入路，采用常規(guī)方法行股骨及脛骨截骨，Ranawat 技術(shù)進行軟組織松解。6 例7 膝采用保留后交叉韌帶型假體，54 例60 膝采用后穩(wěn)定型假體，4 例5 膝采用髁限制型假體。 結(jié)果 術(shù)后患者切口均Ⅰ期愈合。1 例血友病性關(guān)節(jié)炎合并嚴(yán)重膝外翻畸形（股脛角41°）、屈曲攣縮20° 的患者術(shù)后出現(xiàn)腓總神經(jīng)麻痹，經(jīng)保守治療1 年后神經(jīng)功能恢復(fù)。1 例術(shù)后2 年發(fā)生深部感染，行二期翻修術(shù)后治愈?；颊咝g(shù)后均獲隨訪，隨訪時間1 ～ 13 年，平均4.9 年。末次隨訪時X 線片示股脛角為（7.0 ± 2.5）°，與術(shù)前比較差異有統(tǒng)計學(xué)意義（t=15.502，P=0.000）。KSS 臨床評分為（83.0 ± 6.6）分，功能評分（85.1 ± 10.5）分，膝關(guān)節(jié)屈伸活動度為（106.1 ± 17.0）°，與術(shù)前比較差異均有統(tǒng)計學(xué)意義（P  lt; 0.05）。5 例遺留12 ～ 15° 膝外翻畸形，但患膝關(guān)節(jié)功能良好。結(jié)論 通過恰當(dāng)?shù)男g(shù)中截骨和軟組織平衡，采用經(jīng)髕旁內(nèi)側(cè)入路TKA 治療合并膝外翻畸形的終末期膝關(guān)節(jié)病變可有效
改善膝外翻畸形和恢復(fù)關(guān)節(jié)功能，臨床療效滿意。

引用本文： 王興山,翁習(xí)生,林進,金今,錢文偉. 人工全膝關(guān)節(jié)置換術(shù)治療終末期膝關(guān)節(jié)病變合并膝外翻畸形的手術(shù)技巧及臨床療效評價. 中國修復(fù)重建外科雜志, 2012, 26(5): 513-517. doi: 復(fù)制

1. Koskinen E, Remes V, Paavolainen P, et al. Results of total knee replacement with a cruciate-retaining model for severe valgus deformity—a study of 48 patients followed for an average of 9 years. Knee, 2011, 18(3): 145-150.
2. Kamath AF, Israelite C, Horneff J, et al. Editorial: What is varus or valgus knee alignment?: a call for a uniform radiographic classification. Clin Orthop Relat Res, 2010, 468(6): 1702-1704.
3. Krackow KA, Jones MM, Teeny SM, et al. Primary total knee arthroplasty in patients with fixed valgus deformity. Clin Orthop Relat Res, 1991, (273): 9-18.
4. Aglietti P, Sensi L, Cuomo P, et al. Rotational position of femoral and tibial components in TKA using the femoral transepicondylar axis. Clin Orthop Relat Res, 2008, 466(11): 2751-2755.
5. Ranawat AS, Ranawat CS, Elkus M, et al. Total knee arthroplasty for severe valgus deformity. J Bone Joint Surg (Am), 2005, 87 Suppl 1(Pt 2): 271-284.
6. 暢怡, 周殿閣. 初次全膝關(guān)節(jié)置換術(shù)中韌帶加強技術(shù)的應(yīng)用. 中華醫(yī)學(xué)雜志, 2009, 89(21): 1509-1511.
7. Williot A, Rosset P, Favard L, et al. Total knee arthroplasty in valgus knee. Orthop Traumatol Surg Res, 2010, 96(4 Suppl): S37-S42.
8. Krackow KA, Phillips MJ, Mihalko WM. Ligament advancement techniques in primary and revision total knee arthroplasty. Tech Knee Surg, 2003, 2(3): 138-143.
9. Stern SH, Moeckel BH, Insall JN. Total knee arthroplasty in valgus knees. Clin Orthop Relat Res, 1991, (273): 5-8.
10. Hirschmann MT, Hoffmann M, Krause R, et al. Anterolateral approach with tibial tubercle osteotomy versus standard medial approach for primary total knee arthroplasty: does it matter? BMC Musculoskeletal Disorders, 2010, 11: 167.
11. Mertl P, Jarde O, Blejwas D, et al. Lateral approach of the knee with tibial tubercle osteotomy for prosthetic surgery. Rev Chir Orthop Reparatrice Appar Mot, 1992, 78(4): 264-267.
12. Wolff AM, Hungerford DS, Krackow KA, et al. Osteotomy of the tibial tubercle during total knee replacement. A report of twenty-six cases. J Bone Joint Surg (Am), 1989, 71(6): 848-852.
13. Miyasaka KC, Ranawat CS, Mullaji A. 10- to 20-year followup of total knee arthroplasty for valgus deformities. Clin Orthop Relat Res, 1997, (345): 29-37.
14. Keblish PA. The lateral approach to the valgus knee. Surgical technique and analysis of 53 cases with over two-year follow-up evaluation. Clin Orthop Relat Res, 1991, (271): 52-62.
15. Boyer P, Boublil D, Magrino B, et al. Total knee replacement in the fixed valgus deformity using a lateral approach: role of the automatic iliotibial band release for a successful balancing. Int Orthop, 2009, 33(6): 1577-1583.
16. Girard J, Amzallag M, Pasquier G, et al. Total knee arthroplasty in valgus knees: predictive preoperative parameters influencing a constrained design selection. Orthop Traumatol Surg Res, 2009, 95(4): 260-266.
17. Lachiewicz PF, Soileau ES. Results of a second-generation constrained condylar prosthesis in primary total knee arthroplasty. J Arthroplasty, 2011, 26(8): 1228-1231.
18. 劉軍, 孫振輝, 張宇, 等. 改良Ranawat軟組織松解平衡技術(shù)在外翻畸形全膝關(guān)節(jié)置換術(shù)中的應(yīng)用. 中國修復(fù)重建外科雜志, 2009, 23(9): 1034-1037.
19. Idusuyi OB, Morrey BF. Peroneal palsy after total knee arthroplasty. Assessment of predisposing and prognostic factors. J Bone Joint Surg (Am), 1996, 78(2): 177-184.
20. Mihalko WM, Krackow KA. Anatomic and biomechanical aspects of pie crusting posterolateral structures for valgus deformity correction in total knee arhtroplasty: a cadaveric study. J Arthroplasty, 2000, 15(3): 347-353.
21. Rose HA, Hood RW, Otis JC, et al. Peroneal-nerve palsy following total knee arthroplasty. A review of the hospital for special surgery experience. J Bone Joint Surg (Am), 1982, 64(3): 347-351.
  1. 1. Koskinen E, Remes V, Paavolainen P, et al. Results of total knee replacement with a cruciate-retaining model for severe valgus deformity—a study of 48 patients followed for an average of 9 years. Knee, 2011, 18(3): 145-150.
  2. 2. Kamath AF, Israelite C, Horneff J, et al. Editorial: What is varus or valgus knee alignment?: a call for a uniform radiographic classification. Clin Orthop Relat Res, 2010, 468(6): 1702-1704.
  3. 3. Krackow KA, Jones MM, Teeny SM, et al. Primary total knee arthroplasty in patients with fixed valgus deformity. Clin Orthop Relat Res, 1991, (273): 9-18.
  4. 4. Aglietti P, Sensi L, Cuomo P, et al. Rotational position of femoral and tibial components in TKA using the femoral transepicondylar axis. Clin Orthop Relat Res, 2008, 466(11): 2751-2755.
  5. 5. Ranawat AS, Ranawat CS, Elkus M, et al. Total knee arthroplasty for severe valgus deformity. J Bone Joint Surg (Am), 2005, 87 Suppl 1(Pt 2): 271-284.
  6. 6. 暢怡, 周殿閣. 初次全膝關(guān)節(jié)置換術(shù)中韌帶加強技術(shù)的應(yīng)用. 中華醫(yī)學(xué)雜志, 2009, 89(21): 1509-1511.
  7. 7. Williot A, Rosset P, Favard L, et al. Total knee arthroplasty in valgus knee. Orthop Traumatol Surg Res, 2010, 96(4 Suppl): S37-S42.
  8. 8. Krackow KA, Phillips MJ, Mihalko WM. Ligament advancement techniques in primary and revision total knee arthroplasty. Tech Knee Surg, 2003, 2(3): 138-143.
  9. 9. Stern SH, Moeckel BH, Insall JN. Total knee arthroplasty in valgus knees. Clin Orthop Relat Res, 1991, (273): 5-8.
  10. 10. Hirschmann MT, Hoffmann M, Krause R, et al. Anterolateral approach with tibial tubercle osteotomy versus standard medial approach for primary total knee arthroplasty: does it matter? BMC Musculoskeletal Disorders, 2010, 11: 167.
  11. 11. Mertl P, Jarde O, Blejwas D, et al. Lateral approach of the knee with tibial tubercle osteotomy for prosthetic surgery. Rev Chir Orthop Reparatrice Appar Mot, 1992, 78(4): 264-267.
  12. 12. Wolff AM, Hungerford DS, Krackow KA, et al. Osteotomy of the tibial tubercle during total knee replacement. A report of twenty-six cases. J Bone Joint Surg (Am), 1989, 71(6): 848-852.
  13. 13. Miyasaka KC, Ranawat CS, Mullaji A. 10- to 20-year followup of total knee arthroplasty for valgus deformities. Clin Orthop Relat Res, 1997, (345): 29-37.
  14. 14. Keblish PA. The lateral approach to the valgus knee. Surgical technique and analysis of 53 cases with over two-year follow-up evaluation. Clin Orthop Relat Res, 1991, (271): 52-62.
  15. 15. Boyer P, Boublil D, Magrino B, et al. Total knee replacement in the fixed valgus deformity using a lateral approach: role of the automatic iliotibial band release for a successful balancing. Int Orthop, 2009, 33(6): 1577-1583.
  16. 16. Girard J, Amzallag M, Pasquier G, et al. Total knee arthroplasty in valgus knees: predictive preoperative parameters influencing a constrained design selection. Orthop Traumatol Surg Res, 2009, 95(4): 260-266.
  17. 17. Lachiewicz PF, Soileau ES. Results of a second-generation constrained condylar prosthesis in primary total knee arthroplasty. J Arthroplasty, 2011, 26(8): 1228-1231.
  18. 18. 劉軍, 孫振輝, 張宇, 等. 改良Ranawat軟組織松解平衡技術(shù)在外翻畸形全膝關(guān)節(jié)置換術(shù)中的應(yīng)用. 中國修復(fù)重建外科雜志, 2009, 23(9): 1034-1037.
  19. 19. Idusuyi OB, Morrey BF. Peroneal palsy after total knee arthroplasty. Assessment of predisposing and prognostic factors. J Bone Joint Surg (Am), 1996, 78(2): 177-184.
  20. 20. Mihalko WM, Krackow KA. Anatomic and biomechanical aspects of pie crusting posterolateral structures for valgus deformity correction in total knee arhtroplasty: a cadaveric study. J Arthroplasty, 2000, 15(3): 347-353.
  21. 21. Rose HA, Hood RW, Otis JC, et al. Peroneal-nerve palsy following total knee arthroplasty. A review of the hospital for special surgery experience. J Bone Joint Surg (Am), 1982, 64(3): 347-351.