中国组织工程研究

中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (13): 2033-2037.doi: 10.12307/2023.312

• 人工假体 artificial prosthesis • 上一篇    下一篇

股内侧肌下入路全膝关节置换治疗膝外翻畸形的中长期随访

刘洪文1，2，尹  立3，徐文豪3，李  皎3，罗奋棋2，刘绍江1，徐  杰2   

  1. 攀枝花市中心医院，1骨科，3学科建设办公室，四川省攀枝花市   617000；2福建医科大学省立临床医学院，福建省立医院骨科，福建省福州市   350001
  • 收稿日期:2022-03-10 接受日期:2022-06-06 出版日期:2023-05-08 发布日期:2022-08-12
  • 通讯作者: 徐杰，教授，博士生导师，福建医科大学省立临床医学院，福建省立医院骨科，福建省福州市 350001
  • 作者简介:刘洪文，男，四川省攀枝花市人，汉族，南方医科大学在读博士，主要从事关节功能重建研究。 尹立，博士，副教授，硕士生导师，主要从事中西医结合防治老年病及气象医学方面的研究。 徐文豪，主任医师，硕士生导师，主要从事中西医结合基础及临床研究。
  • 基金资助:
    四川省中管局中医药科研专项课题(2020JC0087)，项目负责人：尹立；成都中医药大学学科人才科研专项课题(YYZX20211097)，项目负责人：刘洪文；福建省自然科学基金面上项目(2019J01173)，项目负责人：徐杰

Mid- and long-term follow-up of valgus knees with total knee arthroplasty via subvastus approach

Liu Hongwen1, 2, Yin Li3, Xu Wenhao3, Li Jiao3, Luo Fenqi2, Liu Shaojiang1, Xu Jie2   

  1. 1Department of Orthopedics, 3Department of Discipline Construction Office, Panzhihua Central Hospital, Panzhihua 617000, Sichuan Province, China; 2Department of Orthopedics, Fujian Provincial Hospital, Fujian Medical University, Fuzhou 350001, Fujian Province, China
  • Received:2022-03-10 Accepted:2022-06-06 Online:2023-05-08 Published:2022-08-12
  • Contact: Xu Jie, Professor, Doctoral supervisor, Department of Orthopedics, Fujian Provincial Hospital, Fujian Medical University, Fuzhou 350001, Fujian Province, China
  • About author:Liu Hongwen, Doctoral candidate, Department of Orthopedics, Panzhihua Central Hospital, Panzhihua 617000, Sichuan Province, China; Department of Orthopedics, Fujian Provincial Hospital, Fujian Medical University, Fuzhou 350001, Fujian Province, China Yin Li, MD, Associate professor, Master’s professor, Department of Discipline Construction Office, Panzhihua Central Hospital, Panzhihua 617000, Sichuan Province, China Xu Wenhao, Chief physician, Master’s professor, Department of Discipline Construction Office, Panzhihua Central Hospital, Panzhihua 617000, Sichuan Province, China Liu Hongwen, Yin Li and Xu Wenhao contributed equally to this article.
  • Supported by:
    Sichuan Provincial Administration of Traditional Chinese Medicine Special Project, No. 2020JC0087 (to YL); a Special Project for Scientific Research on Subject Talents of Chengdu University of Traditional Chinese Medicine, No. YYZX20211097 (to LHW); Natural Science Foundation of Fujian Province, No. 2019J01173 (to XJ)

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摘要：

文题释义：
膝外翻畸形：负重位胫股角> 10°可诊断为膝关节外翻畸形，这种畸形的关节会极大增加骨关节炎的风险，而且症状和体征都会比一般的膝骨关节炎更加明显。
股内侧肌下入路：是目前全膝关节置换最为微创的一种手术方式，经股内侧肌下暴露膝关节腔完成截骨和假体安装等操作，不需要切开股四头肌，不破坏伸膝装置，循序膝关节的原始解剖结构，术后疼痛轻，功能恢复快。

背景：股内侧肌下入路是全膝关节置换最微创的一种手术方式，患者术后膝关节功能恢复快，但长期疗效不清楚。
目的：观察股内侧肌下入路全膝关节置换治疗膝外翻畸形中长期的假体位置和膝关节功能情况。
方法：回顾性分析2009年1月至2018年1月福建省立医院骨科收治的膝外翻畸形患者50例共55膝，采用股内侧肌下入路、股骨外翻3°-5°截骨、常规置换髌骨。统计手术时间、显性出血量、切口长度、起始下地时间、起始上下楼梯时间和住院天数等一般资料；采用目测类比评分、膝关节协会功能评分、纽约特种外科医院评分、膝关节屈伸活动度、胫股角、髋-膝-踝角、髁-髋角、平台-踝角等指标评价术后疗效和假体在位情况。
结果与结论：①随访时间为4.7-11.1年；②手术时间(67.2±6.2) min，显性出血量(317.3±109.6) mL，切口长度(11.5±1.2) cm，起始下地时间(1.1±0.5) d，起始上下楼梯时间(2.3±0.9) d，住院天数(4.9±1.2) d；③与术前相比，末次随访时患者目测类比评分显著降低、膝关节活动度、膝关节协会功能评分、纽约特种外科医院评分均显著增加，胫股角/髋-膝-踝角显著降低，髁-髋角/平台-踝角显著降低，差异均有显著性意义(P < 0.001)；④术后均未发生腓总神经麻痹、感染、深静脉栓塞等并发症，随访期间假体位置良好，无翻修病例；⑤提示股内侧肌下入路全膝关节置换治疗膝外翻畸形，中长期假体位置、下肢力线良好，功能恢复满意。

https://orcid.org/0000-0002-7200-4823 (刘洪文) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 股内侧肌下入路, 关节成形术, 膝外翻, 假体位置, 临床疗效

Abstract: BACKGROUND: The subvastus approach is the most minimally invasive surgical method for total knee arthroplasty. The knee joint function recovers quickly after surgery, but the long-term efficacy is unclear.  
OBJECTIVE: To evaluate the mid- and long-term prosthesis position and knee function of valgus knees with total knee arthroplasty via subvastus approach.
METHODS:  A retrospective investigation was conducted among 50 patients (55 knees) with valgus knees in the Department of Orthopedics, Fujian Provincial Hospital from January 2009 to January 2018. Total knee arthroplasty was performed via subvastus approach, femoral distal resection with 3°to 5°of valgus, and the routinely resurfaced patella. The operation time, blood loss, incision length, grounding time, time up and downstairs, and hospital stay were recorded. Visual analogue scale, Knee Society Score, hospital for special surgery, range of motion, femorotibial angle, hip-knee-ankle angle, condylar-hip angle, and plateau-ankle angle were counted to assess postoperative efficacy and prosthesis position.  
RESULTS AND CONCLUSION: (1) Follow-up time was 5.7-11.1 years. (2) The operation time was (67.2±6.2) minutes; blood loss was (317.3±109.6) mL; incision length was (11.5±1.2) cm; grounding time was (1.1±0.5) days; time of up and down stairs was (2.3±0.9) days; hospital stay was (4.9±1.2) days. (3) Compared with preoperative data, visual analogue scale scores decreased significantly. Range of motion, Knee Society Score, and hospital for special surgery score increased significantly at the last follow-up. Femorotibial angle / hip-knee-ankle angle decreased significantly. Condylar-hip angle and plateau-ankle angle decreased significantly (P < 0.001). (4) No postoperative complications such as common peroneal nerve palsy, infection or deep venous embolism occurred. During the follow-up, the prosthesis was in a good position and no revision cases were performed. (5) It is indicated that total knee arthroplasty via subvastus approach for valgus knees can get satisfactory mid- and long-term prosthesis position, lower limb alignment, and functional recovery.

Key words: subvastus approach, arthroplasty, valgus knees, prosthesis position, clinical outcome

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