摘要
目的 探讨不同程度膝内外翻畸形对全膝关节置换（TKA）术后下肢力线的影响。方法 回顾性分析自2012-03—2014-05初次TKA前后均摄双下肢全长负重位X线片的120例膝内外翻畸形,探讨不同程度膝内外翻畸形对TKA术后下肢力线的影响。根据术前髋-膝-踝角（HKA）分为3组,比较3组间术后HKA的差异,并对术前与术后HKA间的关系进行线性回归分析。此外,分析术后下肢机械轴长度（LMAL）相对术前的变化及3组间LMAL平均改变量的差异。结果 所有患肢的HKA、MPTA术前与术后比较,差异均有统计学意义（P〈0.05）,但KPVA术前与术后的差异无统计学意义（P〉0.05）。86.57%（116/134）的患肢TKA术后LMAL比术前延长,差异有统计学意义（P〈0.05）;而非手术侧LMAL术前与术后比较,差异无统计学意义（P〉0.05）。正常组、轻度畸形组和重度畸形组中术后HKA在-3°-3°范围内分别占90.48%、81.25%和34.69%,差异有统计学意义（P〈0.05）。术前与术后HKA散点图分析表明两者间存在线性回归关系。此外,术前HKA与术前KPVA散点图分析表明,两者间存在线性回归关系（F=51.197,P〈0.001）。3组间术前KPVA、术前MPTA的组间比较,差异均有统计学意义（P〈0.05）。结论 膝内外翻严重畸形可增加TKA术后下肢力线的偏差,TKA术后LMAL大多比术前延长,其中伴有膝内外翻严重畸形延长最明显。
Objective To investigate influence of varying degrees of varus or valgus knee deformity on lower-extremity alignment after total knee arthroplasty（TKA）. Methods This retrospective study included 120 patients who underwent primary TKA and had pre- and postoperative weight-bearing full-length X-rays of lower extremities from March 2012 to May2014, in order to discuss influence of varying degrees of varus or valgus knee deformity on lower-extremity alignment after TKA. Results There was statistically significant difference in the pre- and postoperative HKA among the three groups（ P〈0.05）, furthermore, the preoperative MPTA was significantly different from the postoperative MPTA among the three groups（P〈0.05）, but there was no statistically significant difference in the pre- and postoperative KPVA among the three groups（ P〉0.05）. 86.57%（116/134） of all the operative limbs showed increased LMAL after TKA, and the difference was statistically significant（P〈0.05）. There was no statistically significant difference between preoperative and postoperative LMAL in the nonoperative limbs（P〉0.05）. The percentage of the postoperative HKA within 3° in the normal group, mild deformity group and severe deformity group was 90.48%, 81.25% and 34.69%, respectively, and there was statistically significant different among the three groups（P〈0.05）. Scatter plot showed that there was a liner regression relation between the preoperative and postoperative HKA（F =99.060,P 〈0.001）. In addition, scatter plot showed that there was also liner regression relation between the preoperative HKA and KPVA（F =51.197,P〈 0.001）. There was significant difference in the preoperative KPVA among the three groups. Moreover, there was also distinct difference in the preoperative MPTA among the three groups. Conclusion The severity of the knee varus or valgus deformity might increase the postoperative lower limb alignment deviation from neutral mechanical axis in TKA. LMAL lengthening is common after TKA, and the patients with severe varus or valgus knee deformity are the most outstanding on the lengthening.
出处
《中国骨与关节损伤杂志》
2015年第12期1254-1258,共5页
Chinese Journal of Bone and Joint Injury
关键词
膝内外翻畸形
下肢力线
全膝关节置换术
Knee deformity
Lower-extremity alignment
Total knee arthroplasty
