保留内侧副韧带深层的外翻膝全膝关节置换术

IF 1.1 4区医学 Q3 ORTHOPEDICS

Acta orthopaedica et traumatologica turcica Pub Date : 2022-05-01 DOI:10.5152/j.aott.2022.21161

Hiroshi Ohno, Minoru Murata, T. Kamo, Hideo Sugimoto, Takanori Saito

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引用次数: 0

摘要

目的:评价保留内侧副韧带深层全膝关节置换术治疗外翻膝的疗效和并发症，如胫股不稳定和外翻畸形复发。方法:本研究纳入33例(男4例，女29例)股骨胫骨站立角<170°的膝关节36例(骨关节炎26例，类风湿性关节炎10例)。34个膝关节使用后路稳定(PS)假体，2个膝关节使用旋转铰链假体。手术由一名外科医生进行，以保护内侧副韧带的深层。患者手术时平均年龄67.6±12岁，平均随访时间9.0±3年(范围4 ~ 15年)。日本骨科协会(JOA)膝关节评分，活动范围(ROM)(伸/屈;以度计)、FTA(以度计)及并发症的调查。结果:日本骨科协会膝关节评分由术前平均51±12分显著提高至术后平均86±9分(P <0.001)。伸关节和屈曲关节分别从-13±13°改善至术后平均-2±4°，从115±25°改善至术后平均125±18°(P <0.001)。站立FTA由158±9°显著改善至173±2°(P <0.001)。34例严重外翻畸形膝关节采用后路稳定植入物，仅有2例膝关节需要约束植入物。随访期间无胫股不稳、外翻畸形复发、髌骨坏死、深部感染、创面问题、腓神经麻痹等并发症发生。结论:本研究表明外翻膝畸形行保留d-MCL的TKA术后临床效果良好，无并发症发生。证据等级:IV级，治疗性研究

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A New Total Knee Arthroplasty Technique for Valgus Knees that preserves the deep layer of the medial collateral ligament

Objective: The aim of this study was to assess the outcomes and complications, such as tibiofemoral instability and recurrence of valgus deformity, of total knee arthroplasty for valgus knees with a new technique preserving the deep layer of the medial collateral ligament. Methods: In this study 33 (4 male and 29 female) patients, and a total of 36 (26 knees with osteoarthritis and 10 with rheumatoid arthritis) knees with a standing femorotibial angle (FTA) of <170° were included. Posterior Stabilized (PS) implants were used in 34 knees, rotating hinged knee implants were used in 2 knees. The procedures were carried out by a single surgeon protecting the deep layer of the medial collateral ligament. The patients’ average age at the time of the operation was 67.6 ± 12 years, and the average follow-up period was 9.0 ± 3 years (range, 4-15 years). The Japanese Orthopaedic Association (JOA) knee score, range of motion (ROM) (extension/flexion; measured in degrees), FTA (measured in degrees) and complications were investigated. Results: The Japanese Orthopaedic Association knee score significantly improved from an average of 51 ± 12 points before the operation to 86 ± 9 points after the operation (P <0.001). The extension ROM and flexion ROM improved from, -13 ± 13° to a postoperative average of -2 ± 4°, and 115 ± 25° to a postoperative average of 125 ± 18° respectively (P <0.001). The standing FTA significantly improved from 158 ± 9° to an average of 173 ± 2° after the operation (P <0.001). Thirty-four knees with severe valgus deformity were operated on using posterior stabilised implants, while only two knees required constrained implants. During follow-up, no complications, such as tibiofemoral instability, recurrence of valgus deformity, patellar necrosis, deep infection, wound problems, or peroneal nerve paralysis were observed. Conclusion: This study has shown us that after performing TKA while preserving the d-MCL for valgus knee deformity good clinical results were obtained and no complications were observed. Level of Evidence: Level IV, Therapeutic Study

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来源期刊

Acta orthopaedica et traumatologica turcica ORTHOPEDICS-

CiteScore

2.00

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： Acta Orthopaedica et Traumatologica Turcica (AOTT) is an international, scientific, open access periodical published in accordance with independent, unbiased, and double-blinded peer-review principles. The journal is the official publication of the Turkish Association of Orthopaedics and Traumatology, and Turkish Society of Orthopaedics and Traumatology. It is published bimonthly in January, March, May, July, September, and November. The publication language of the journal is English. The aim of the journal is to publish original studies of the highest scientific and clinical value in orthopedics, traumatology, and related disciplines. The scope of the journal includes but not limited to diagnostic, treatment, and prevention methods related to orthopedics and traumatology. Acta Orthopaedica et Traumatologica Turcica publishes clinical and basic research articles, case reports, personal clinical and technical notes, systematic reviews and meta-analyses and letters to the Editor. Proceedings of scientific meetings are also considered for publication. The target audience of the journal includes healthcare professionals, physicians, and researchers who are interested or working in orthopedics and traumatology field, and related disciplines.