摘要
目的探索外翻膝人工全膝关节置换入路与软组织平衡的新技术。方法设计并应用于临床兼有松解髌外侧支持带功能的改良髌旁外侧入路,通过平行分离髌骨外侧支持带深浅两层,并向外翻转脂肪垫暴露膝关节,术中松解髌骨外侧支持带、髂胫束或膝关节后外侧关节囊、膝外侧副韧带等紧张结构,假体安装后错位缝合外侧支持带深层与浅层,既维持了松解的外侧支持带的适当张力和髌股关节正常活动轨迹,又确保了术后深筋膜的闭合。术后2周内行CPM锻炼,2周后扶拐行走。结果11例患者下肢力线从术前平均外翻10.2°矫正至平均内翻1.5°,膝关节冠状面畸形矫正率达85.3%。术后伤口愈合良好,术后2个月伸屈活动度平均达105°,11例患者均可自如地平地行走,其中9例可上下楼梯。膝关节稳定性好。结论改良髌旁外侧入路能较方便地显露膝关节外侧稳定结构,有利于对外侧挛缩结构的精确松解,并保持良好的髌股关节活动轨迹,是严重外翻膝行全膝关节置换的良好入路。
Objective To explore a new approach giving soft tissue balance in valgus knee during total knee arthroplasty. Methods A modified lateral parapatellar approach with function of spontaneous release of lateral retinaculum was designed and used for valgus knee during total knee arthroplasty, by which knee joint was exposed with incision between the superficial and deep retinaculum layer together with lateral eversion of fat pad. After release of the constrained structures of the knee at lateral side such as lateral retinaculum, iliotibial band,lateral posterior capsule or lateral collateral ligament the prosthesis was implanted; the superficial and deep retinaculum layers were sutured back in proper tension position in order to maintain a normal patella femoral relationship and then the deep layer was closed. Within 2 weeks after operation CPM was instituted and ambulation was allowed with crutches 2 weeks after operation. Results All of 11 cases so treated healed up without skin problem. The valgus deformities were mostly corrected with a rate of 85.3% from average 10.2 degrees valgus preoperatively to average 1.5 degrees varus postoperatively. Two months postoperation the average range of motion reached 105 degrees and the knees were stable in level walking. Nine of 11 cases were able to go up and down stairs. Conclusion Modified lateral parapatellar approach was suitable for total knee arthroplasty with severe valgus deformity. [
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2001年第12期714-717,共4页
Chinese Journal of Orthopaedics
