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。

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。

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。

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。

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

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.

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.

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.