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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (02) : 248 -251. doi: 10.3877/cma.j.issn.1674-134X.2021.02.019

所属专题： 文献；

临床经验

"馅饼皮"技术处理膝关节置换软组织平衡的效果
赵罡1,†(), 罗茗1, 崔沈杞1   
  1. 1. 466000　周口骨科医院
  • 收稿日期:2020-12-16 出版日期:2021-04-01
  • 通信作者: 赵罡

Effect of pie-crusting technique on soft tissue balance in total knee arthroplasty

Gang Zhao1,†(), Ming Luo1, Shenqi Cui1   

  1. 1. Zhoukou Orthopaedic Hospotal, Zhoukou 466000, China
  • Received:2020-12-16 Published:2021-04-01
  • Corresponding author: Gang Zhao
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赵罡, 罗茗, 崔沈杞. "馅饼皮"技术处理膝关节置换软组织平衡的效果[J]. 中华关节外科杂志(电子版), 2021, 15(02): 248-251.

Gang Zhao, Ming Luo, Shenqi Cui. Effect of pie-crusting technique on soft tissue balance in total knee arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(02): 248-251.

目的

比较在膝关节置换术(TKA)中，利用"pie-crusting"技术处理不同膝内翻程度患者的手术效果。

方法

回顾近年来在周口骨科医院关节科行TKA的终末期膝骨关节炎(KOA)患者。根据膝关节内翻角度是否超过20°，分为重度内翻组、非重度内翻组。对关节活动度(ROM)、美国膝关节协会(KSS)评分、影像学"髋—膝—踝(HKA)角"进行t检验，并记录术中、术后并发症情况。

结果

共纳入37例研究对象，随访26～68个月。重度内翻组21例、非重度内翻组16例，两组患者的年龄(t＝0.231)、性别(χ2＝27.493)、身体质量指数(BMI)(t＝-1.279)差异无统计学意义(P>0.05)；术前膝关节ROM(t＝-7.323)、KSS评分(t＝-2.407)、HKA角度(t＝5.654)等比较，重度内翻组明显劣于非重度内翻组，差异具有统计学意义(P<0.05)。TKA术后，两组患者的膝关节ROM(t＝1.381)、KSS评分(t＝-1.093)、HKA角(t＝1.458)均较术前得到改善，且两组患者之间的差异不具有统计学意义(P>0.05)。术后发生假体周围骨折1例(2.7%)，予以切开复位内固定后骨性愈合；手术切口皮肤红肿1例(2.7%)，予以碘伏纱布湿敷，术后2周拆线，该病例共随访58个月，期间未出现假体周围感染；1例(2.7%)患者出现了假体无菌性松动，采用了髁限制性假体进行翻修。

结论

在TKA术中利用"pie-crusting"技术和综合方法处理软组织平衡，可以使不同程度膝关节内翻、屈曲畸形患者也可获得良好的术后康复效果。

关键词: 关节成形术, 置换, 膝, 骨关节炎, 膝, 内侧副韧带, 膝
Objective

To compare the surgical outcomes of patients treated with different degrees of knee varus utilizing the pie-crusting technique in total knee arthroplasty (TKA).

Methods

The patients with end-stage knee osteoarthritis (KOA) who underwent TKA at the Joint Surgical Department of Zhoukou Orthopaedic Hospital in recent years were reviewed. They were divided into the severe varus group and the non-severe varus group according to whether the knee varus angle exceeded 20 degrees. The t test was performed for joint mobility (ROM), American Knee Society (KSS) score, hip knee ankle (HKA). The complications were recorded.

Results

A total of 37 subjects were included and followed up for 26 to 68 months. There were 21 cases in the severe varus group and 16 cases in the non-severe varus group. There was no significant difference in age(t=0.231), gender(χ2=27.493) or body mass index (BMI)( t=-1.279) between the two groups (P> 0.05). The preoperative ROM(t=-7.323), KSS score(t=-2.407) and HKA angle(t=5.654) of knee joint in severe varus group were significantly worse than those in non-severe varus group (P< 0.05). After TKA, the knee ROM(t=1.381), KSS score(t=-1.093) and HKA angle(t=1.458) of the two groups were improved, yet the difference between the two groups was not statistically significant (P> 0.05). Postoperative periprosthetic fracture occurred in one case (2.7%), which was bony union after open reduction and internal fixation. Skin redness and swelling occurred in 1 case (2.7%) and was wet applied with Iodophor gauze, and stitches were removed 2 weeks after operation. The patient was followed up for 58 months, during which no periprosthetic infection occurred. Aseptic loosening occurred in one case (2.7%), and condylar limited prosthesis was used for revision.

Conclusion

Using "pie-crusting" technique and comprehensive method to deal with soft tissue balance in TKA can make patients with different degrees of knee varus and flexion deformity obtain good postoperative effect.

Key words: Arthroplasty, replacement, knee, Osteoarthritis, knee, Medial collateral ligament, knee
表1 两组TKA患者一般情况及术前情况比较
分组 例数 年龄[岁，(±s)] 性别(例) BMI[kg/m2，(±s)]
男 女
重度内翻组 21 64.0±10.0 9 12 24.3±2.1
非重度内翻组 16 65.0±11.0 5 11 25.2±2.5
统计值   t＝-0.231 χ2＝27.493 t＝-1.279
P值   >0.05 >0.05 >0.05
分组 例数 术前ROM[°，(±s)] 术前KSS评分(±s) 术前HKA[°，(±s)]
重度内翻组 21 61.9±4.5 34.8±8.7 164±4.8
非重度内翻组 16 74.2±5.8 43.6±13.5 156.1±3.3
统计值   t＝-7.323 t＝-2.407 t＝5.654
P值   <0.05 <0.05 <0.05
表2 两组患者术后情况比较
分组 例数 术后2年ROM[°，(±s)] 术后2年KSS评分(±s) 术后HKA[°，(±s)]
重度内翻组 21 110.7±5.7 83.3±12.5 180.3±1.6
非重度内翻组 16 108.4±4.2 87.6±11.2 179.6±1.4
t值   1.381 -1.093 1.458
P值   >0.05 >0.05 >0.05
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