探讨不同组配式全膝关节假体治疗中、重度外翻膝的临床疗效。

回顾性分析2012年3月至2016年8月因中、重度膝外翻畸形行全膝关节表面置换术患者，排除轻度外翻膝及下肢解剖轴线明显异常者，根据手术方式及假体的不同分为A组：常规膝假体＋延长杆TKA术；B组：髁限制假体＋延长杆TKA术；C组：股骨髁上截骨＋延长杆TKA术。通过测量股胫关节角，视觉模拟评分，膝关节功能评分评价患肢关节功能和手术疗效。组内手术前后比较采用配对样本t检验，组间采用重复测量资料方差分析。

43例患者(59膝)均获得术后随访，平均时间为(16±3)个月；男12例14膝，女31例45膝；年龄平均(56.5±1.7)岁。其中A组19例(27膝)，B组13例(18膝)，C组11例(14膝)，术后所有病例均未出现感染、关节不稳、假体松动等并发症，末次随访各组患肢股胫关节角(t＝22.544，20.221，12.841)、视觉模拟评分(t＝17.979，16.398，13.962)，膝关节功能评分(t＝－35.159，－29.649，－25.410)较术前明显改善，各组手术前后疗效评价差异有统计学意义(P <0.05)；三组间手术前后患膝股胫关节角，视觉模拟评分，膝关节功能评分差异无统计学意义(P >0.05)。

根据膝外翻畸形的病理特点和临床分型，灵活优化组配不同假体均能获得满意疗效，兼顾矫形的同时也最大限度地增加假体把持力和关节稳定性，对于关节外畸形行髁上截骨＋生物延长杆固定是不错选择。

To investigate the clinical effect of different modular knee prosthesis in treating moderate to severe genu valgum.

Retrospective analysis was conducted on the patients who underwent total knee replacement due to moderate or severe valgus knee deformity from March 2012 to August 2016, excluding the patients with mild valgus knee deformity and significant abnormalities in the anatomical axis of the lower limbs. According to the different surgical and prostheses, they were divided into three groups. Group A: conventional knee prosthesis with extension pole group; group B: condylar constrained knee with extension pole group; group C: supracondylar osteotomy with extension pole group. Joint function and surgical effect of the affected limb were evaluated by measuring femorotibial angle, visual analogue score and knee function score. Paired sample t test was used for intra-group comparison before and after surgery, and repeated measurement data ANOVA was used for inter-group comparison.

All the 43 patients (59 knees) were followed up postoperatively with an average time of (16±3) months. There were 12 male cases with 14 knees and 31 female cases with 45 knees. The average age was (56.5±1.7) years. Among them, there were 19 patients (27 knees) in group A, 13 patients (18 knees) in group B, and 11 patients (14 knees) in group C. No postoperative complications such as infection, joint instability, and prosthesis loosening occurred in all patients. At the last follow-up, the femorotibial angle(t=17.979, 16.398, 13.962), visual analogue score (t=-35.159, -29.469, 25.410) and knee function score (t=22.544, 20.221, 12.841) of the affected limb in each group were significantly improved compared with those before and after operation (P<0.05). There were no statistically significant differences in femorotibial angle, visual analogue score and knee function score among the three groups before and after TKA surgery (P>0. 05).

According to the pathological characteristics and clinical classification of genu valgus deformity, the flexible optimization of the combination of different prostheses can achieve satisfactory results, and at the same time maximize the prosthesis-holding capacity and joint instability, so the supracondylar osteotomy with extension is a good way to treat the deformity of knee joint.