摘要
目的 :观察保留后交叉韧带人工全膝置换治疗严重膝内翻畸形患者的临床结果。方法 :回顾性分析 1990年 1月～ 1995年 7月间严重膝内翻畸形骨关节炎患者 (≥ 2 0°)人工全膝置换后的临床结果。假体为Miller Galante Ⅰ人工全膝 (MG Ⅰ ,Zimmer公司 )。采用KSS评分对临床结果进行评估。结果 :38人 5 6膝获完整随访 ,平均随访 6 ( 4～ 9)年。术前至最后一次随访 ,平均膝评分从 33分提高到 91分 ,其中 84%优秀 ;平均膝关节功能评分自 39增加到 76分 ;两者的改善均有统计学意义 (P <0 .0 1)。 86 %的患者膝关节活动度超过 90° ,多数病例 ( 5 0 /5 6 )术后膝关节力线正常 ,6例残留 5～ 10°内翻畸形。总翻修率 2 1% ( 12 /5 6 ) ,平均翻修时间为术后 5 .5年。其它并发症包括髌骨半脱位 ,膝前痛 ,浅表感染。无深部感染、假体松动及前后向不稳。结论 :保留后交叉韧带人工全膝可矫正严重膝内翻畸形 ,术后内。
Objectives:To observe the clinical outcomes of PCL retaining TKA in patients with severe varus deformity Method:We reviewed the clinical reults of primary TKA in patients with severe varus deformity(≥20 degrees). All patients suffered from osteoarthritis. All the TKA were performed by a single surgeon using a minimally constrained 'Hybrid' Miller Galante knees(MG 1,Zimmer, Warsaw,Ind) between Jan 1990 and July 1995. Clinical evaluation was performed using the Knee Society clinical rating system. The Student's t test was used to analyze the data. Results: At a mean follow up of 6 years (range 4～9),56 knees in 38 patients were available for review. 5 patients (7 knees) were lost to follow up and 3 patients (4 knees) had died. The average Knee Score improved from 33points before operation to 91 points at the latest follow up with excellent result in 84% patients. The Knee Society Functional score improved from 39 to 76 points. The improvements were statistically significant(p<0.01, paired t test).A functionally acceptable ROM of more than 90 degrees were achieved in 86% of all patients. Most of cases (50/56) had postoperative alignment inside the normal range of 5 to 7 degrees valgus. 6 cases had postoperative residual deformity of 5～10 degrees varus. Total revision rate was 21%(12/56),the average revision time was 5.5 years after primary TKA. Other complication included patellar subluxation in 1 case,anterior pain of knee in 4 cases,superficial cellulitis in 1 case.No recent or late infection, aseptic loosening and anterioposterior instability occurred in this series. Conclusion:Severe varus deformity can be successfully corrected at the time of primary TKA using PCL sparing prosthesis.There were more problems from postoperative medial lateral instability of knee which contributed significantly to early failure after an average of 6.0 years.
出处
《中国矫形外科杂志》
CAS
CSCD
2001年第12期1153-1156,共4页
Orthopedic Journal of China
关键词
后交叉韧带
全膝关节成形
内翻畸形
Posterior cruciate ligament
Total knee arthroplasty
Varus deformity
