全膝关节置换术治疗膝关节骨性关节病伴股骨关节外畸形:一个病例系列

Calvin Tsoi, Y. Wong
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引用次数: 1

摘要

一个成功的全膝关节置换术(TKA)需要恢复机械轴和软组织平衡。胫骨和股骨畸形发生于创伤或截骨史、感染、代谢性骨病和过度弯曲。在全膝关节置换术中处理先前存在的下肢关节外畸形是具有挑战性的,因为难以恢复对齐轴和软组织平衡。从1995年到2017年,我们记录了6例通过关节内矫正接受全膝关节置换术的患者,这些患者先前存在股骨关节外畸形。所有患者均因骨折不愈合导致股骨关节外畸形,采用保守、钢板或髓内钉治疗。冠状畸形从中性轴平均15.5度矫正到4.6度。矢状面畸形从平均6.8度矫正到3.6度。1例患者在7年随访中出现进行性膝后屈,活动范围为25度伸展和110度屈曲。术前西安大略和麦克马斯特大学骨关节炎指数(WOMAC)平均评分为68.5(范围51 - 87),术后12个月降至50.7(范围21-71),膝关节评分平均为53.3(范围51 - 55),平均上升至88.5(范围82-94)。全膝关节置换术(TKR)后16年只有一例无菌性松动的翻修,没有其他无菌性松动的放射学征象。总之,对于远离膝关节的轻度至中度畸形,关节内股骨关节外畸形矫治TKR是一种有吸引力的方法。
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Knee osteoarthrosis with extra-articular femoral deformity treated with total knee arthroplasty: A case series
A successful Total knee arthroplasty (TKA) procedure requires restoration of mechanical axis and soft tissue balancing. Deformity of tibia and femur occurs with history of trauma or osteotomy, infection, metabolic bone disease and excessive bowing. Tackling pre-existing extra-articular deformity of lower limbs during total knee arthroplasty can be challenging due to difficulty in restoring alignment axis and soft tissue balancing. We have recorded 6 patients underwent total knee arthroplasty with preexisting extra-articular femoral deformity by intra-articular correction from 1995 to 2017. All patients had extra-articular deformity of the femur due to fracture malunion which were treated either conservatively, plating or intra-medullary nail. Coronal deformity is corrected from an average of 15.5 degrees to 4.6 degrees from neutral axis. Sagittal deformity is corrected from average of 6.8 degrees to 3.6 degrees. One patient developed progressive genu recurvatum at 7 years follow-up with range of motion at 25 degrees extension and 110 degrees flexion. The average pre-operative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was 68.5 (range 51−87) decreased to 50.7 (range 21–71) at 12 months post-operative and Knee score averaged 53.3 (range 51–55) increased to an average of 88.5 (range 82–94). There was only one revision for aseptic loosening 16 years after total knee replacement (TKR) and no other cases of radiological sign of aseptic loosening. In conclusion, Intra-articular correction of an extra articular femoral deformity for TKR is an attractive approach in mild to moderate deformity further from the knee joint.
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CiteScore
0.60
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0.00%
发文量
36
审稿时长
8 weeks
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