[1]李思宁,王直兵,程兴旺,等.残留轻度内翻不影响弓形股骨膝内翻膝关节置换的临床效果[J].陆军军医大学学报(原第三军医大学学报),2021,43(22):2462-2467.
　LI Sining,WANG Zhibing,CHENG Xingwang,et al.Slight varus malalignment has no influence on clinical function in patients with femoral lateral bowing after total knee replacement[J].J Amry Med Univ (J Third Mil Med Univ),2021,43(22):2462-2467.
点击复制

残留轻度内翻不影响弓形股骨膝内翻膝关节置换的临床效果(/HTML )
分享到：

陆军军医大学学报（原第三军医大学学报）[ISSN:1000-5404/CN:51-1095/R]

卷:
43卷
期数:
2021年第22期
页码:
2462-2467
栏目:
临床医学
出版日期:
2021-11-30

文章信息/Info

Title:
Slight varus malalignment has no influence on clinical function in patients with femoral lateral bowing after total knee replacement
作者:
李思宁; 王直兵; 程兴旺; 张峡
陆军军医大学（第三军医大学）第二附属医院骨科
Author(s):
LI Sining;  WANG Zhibing;  CHENG Xingwang;  ZHANG Xia

Department of Orthopedics, Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China

关键词:
膝骨关节炎; 全膝关节置换术; 股骨外弓; 内翻膝
Keywords:
osteoarthritis;  total knee arthroplasty;  femora lateral bowing;  varus knees
分类号:
R615; R684.2; R687.4
文献标志码:
A
摘要:

目的探讨全膝关节置换(total knee arthroplasty, TKA)时，残留轻度下肢内翻对股骨外弓膝内翻患者功能的影响。方法采用回顾性队列研究设计，收集2015年1-12月在我科行TKA的152例下肢力线内翻的内侧膝骨关节炎(medial osteoarthritis of the knee, MOA)患者病例资料。根据术后的下肢力线将患者分为3组：轻度内翻(>3°～6°，A组)，重度内翻(>6°，B组)，中立位(-3°～3°，C组)。平均随访4.3年，比较各组间的国际膝关节协会(international knee society score, KSS)及麦克马斯特大学骨关节炎指数（Western Ontario and McMaster University Osteoarthritis Index， WOMAC）评分。结果随访期间，各组均无患者出现翻修。术后力线分别为A组术前（9.8±3.2）°，术后（4.3±0.6）°；B组术前（10.8±1.6）°，术后（7.1±1.2）°；C组术前（8.8±3.5）°，术后（0.6±1.3）°。术后各组KSS评分均有所提高，与C组[(157.0±29.4)分，P=0.02]及B组[(150.9±32.3)分，P=0.01]相比，A组总的KSS评分(167.5±26.1)提高更显著；功能评分上，与B组(P=0.04)及C组(P= 0.01)相比，A组的KSS评分提高更显著；膝关节评分上，A组较B组改善更明显(P=0.03)，但与C组相似。WOMAC评分上，与C组相比，A组具有更低的WOMAC总评分(P=0.02)、日常活动度（P=0.02）及僵硬度评分(P=0.03)；B组和C组具有相近的WOMAC评分。结论股骨外弓膝内翻患者行TKA时，残留轻度下肢内翻（>3°～6°）不影响术后的短期效果。

Abstract:

ObjectiveTo investigate the effect of residual slight varus malalignment after total knee arthroplasty (TKA) on the function in patients with femoral lateral bowing and medial osteoarthritis of the knee (MOA).  MethodsA retrospective cohort study was performed on 152 patients suffering from femoral lateral bowing and MOA and undergoing TKA in our hospital from January to December 2015. After a mean follow-up period of 4.3 years, the patients were stratified into mild varus (>3°～6°, group A，n=45), severe varus (>6°, group B, n=26), and neutral (-3°～3°, group C, n=81) groups based upon their post-operative alignment. The International Knee Society Score (KSS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores were compared among the groups.  ResultsNo implant was revised during the follow-up period. The patients in the group A were averagely corrected from (9.8±3.2)° pre-operatively to (4.3±0.6)° post-operatively, those in the group B from (10.8±1.6)° to (7.1±1.2)°, and those in the group C from (8.8±3.5)° to (0.6±1.3)°. KSS scores were increased following TKA for all the groups. The group A scored significantly better in the total KSS score (167.5±26.1) as compared with the group C (157.0±29.4, P=0.02) and group B (150.9±32.3, P=0.01). In the functional sub-scores, a significantly better score was obtained in the group A when compared with the group B and group C (P=0.04, 0.01). The knee sub-score of the group A was significantly better than those of the group B (P=0.03), but was similar to that of the group C. With regard to the WOMAC score, the group A scored significantly lower than the group C in the total score (P=0.02) and in 2 of the sub-scores (Activities of daily living: P=0.02; stiffness: P=0.03). WOMAC scores were similar between the group B and C. ConclusionOur study indicates that mild varus malalignment (>3°～6°) didn’t influence the effect of TKA for patients with femoral lateral bowing and MOA at the short-term follow-up period.

参考文献/References:

[1]LEE B S, LEE S J, KIM J M, et al. No impact of severe Varus deformity on clinical outcome after posterior stabilized total knee arthroplasty[J]. Knee Surg Sports Traumatol Arthrosc, 2011, 19(6): 960-966. DOI: 10.1007/s00167-010-1316-9. 
 
[2]MAGNUSSEN R A, WEPPE F, DEMEY G, et al. Residual Varus alignment does not compromise results of TKAs in patients with preoperative Varus[J]. Clin Orthop Relat Res, 2011, 469(12): 3443-3450. DOI: 10.1007/s11999-011-1988-6. 
 
[3]MATZIOLIS G, ADAM J, PERKA C. Varus malalignment has no influence on clinical outcome in midterm follow-up after total knee replacement[J]. Arch Orthop Trauma Surg, 2010, 130(12): 1487-1491. DOI: 10.1007/s00402-010-1064-9. 
 
[4]PARRATTE S, PAGNANO M W, TROUSDALE R T, et al. Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements[J]. J Bone Joint Surg Am, 2010, 92(12): 2143-2149. DOI: 10.2106/JBJS.I.01398. 
 
[5]王波, 胡海涛, 潘健, 等. 膝关节骨性关节炎全膝关节置换术后下肢力线与早期临床效果关系的研究[J]. 中国骨与关节损伤杂志, 2015, 30(10): 1044-1048. DOI: 10.7531/j.issn.1672-9935.2015.10.012. 
 
WANG B, HU H T, PAN J,et al. Relationship between lower limb alignment and early clinical results after TKA for osteoarthritis[J]. Chin J Bone Jo Inj, 2015, 30(10): 1044-1048. DOI: 10.7531/j.issn.1672-9935.2015.10.012. 
 
[6]HOWELL S M, PAPADOPOULOS S, KUZNIK K T, et al. Accurate alignment and high function after kinematically aligned TKA performed with generic instruments[J]. Knee Surg Sports Traumatol Arthrosc, 2013, 21(10): 2271-2280. DOI: 10.1007/s00167-013-2621-x. 
 
[7]BELLEMANS J, COLYN W, VANDENNEUCKER H, et al. The Chitranjan Ranawat award: is neutral mechanical alignment normal for all patients? The concept of constitutional Varus[J]. Clin Orthop Relat Res, 2012, 470(1): 45-53. DOI: 10.1007/s11999-011-1936-5. 
 
[8]VICTOR J, URLUS M, BELLEMANS J, et al. Femoral intramedullary instrumentation in total knee arthroplasty: the role of pre-operative X-ray analysis[J]. Knee, 1994, 1(2): 123-125. DOI: 10.1016/0968-0160(94)90025-6. 
 
[9]王本超, 陈森, 方洪松, 等. 股骨畸形对TKA术后下肢力线及膝关节线的影响[J]. 中国骨与关节损伤杂志, 2018, 33(12): 1247-1250. DOI: 10.7531/j.issn.1672-9935.2018.12.005. 
 
WANG B C, CHEN S, FANG H S,et al. Influence of femur deformity on lower limb force line and joint line after total knee arthroplasty[J]. Chin J Bone Joint Injury, 2018, 33(12): 1247-1250. DOI: 10.7531/j.issn.1672-9935.2018.12.005. 
 
[10]叶一林, 柴卫兵, 卢宏章, 等. 伴有关节外畸形的膝骨关节炎行全膝关节置换术的治疗体会[J]. 中国骨与关节外科, 2014, 7(5): 399-403. DOI: 10.3969/j.issn.1674-1439.2013.10-011. 
 
YE Y L, CHAI W B, LU H Z,et al. Clinical experience of total knee arthroplasty for osteoarthritis associated with severe extra-articular femoral deformity[J]. Chin J Bone Joint Surg, 2014, 7(5): 399-403. DOI: 10.3969/j.issn.1674-1439.2013.10-011. 
 
[11]SIKORSKI J M. Alignment in total knee replacement[J]. J Bone Joint Surg Br, 2008, 90(9): 1121-1127. 
 
[12]MORELAND J R, BASSETT L W, HANKER G J. Radiographic analysis of the axial alignment of the lower extremity[J]. J Bone Joint Surg, 1987, 69(5): 745-749. DOI: 10.2106/00004623-198769050-00016. 
 
[13]COOKE T D, SLED E A, SCUDAMORE R A. Frontal plane knee alignment: a call for standardized measurement[J]. J Rheumatol, 2007, 34(9): 1796-1801. 
 
[14]HVID I, NIELSEN S. Total condylar knee arthroplasty: Prosthetic component positioning and radiolucent lines[J]. Acta Orthop Scand, 1984, 55(2): 160-165. DOI: 10.3109/17453678408992329. 
 
[15]LEE H J, LIM J W, LEE D H, et al. Slight under-correction using individualized intentional varus femoral cutting leads to favorable outcomes in patients with lateral femoral bowing and varus knee[J]. Knee Surg Sports Traumatol Arthrosc, 2020, 28(5): 1579-1586. DOI: 10.1007/s00167-019-05577-1. 
 
[16]NISHIDA K, MATSUMOTO T, TAKAYAMA K, et al. Remaining mild Varus limb alignment leads to better clinical outcome in total knee arthroplasty for varus osteoarthritis[J]. Knee Surg Sports Traumatol Arthrosc, 2017, 25(11): 3488-3494. DOI: 10.1007/s00167-016-4260-5. 
 
[17]MULLAJI A B, MARAWAR S V, MITTAL V. A comparison of coronal plane axial femoral relationships in Asian patients with varus osteoarthritic knees and healthy knees[J]. J Arthroplasty, 2009, 24(6): 861-867. DOI: 10.1016/j.arth.2008.05.025. 
 
[18]YAU W P, CHIU K Y, TANG W M, et al. Coronal bowing of the femur and tibia in Chinese: its incidence and effects on total knee arthroplasty planning[J]. J Orthop Surg (Hong Kong), 2007, 15(1): 32-36. DOI: 10.1177/230949900701500108. 
 
[19]WERNER F W, AYERS D C, MALETSKY L P, et al. The effect of valgus/varus malalignment on load distribution in total knee replacements[J]. J Biomech, 2005, 38(2): 349-355. DOI: 10.1016/j.jbiomech.2004.02.024. 
 
[20]SHARKEY P F, HOZACK W J, ROTHMAN R H, et al. Insall Award paper. Why are total knee arthroplasties failing today? [J]. Clin Orthop Relat Res, 2002(404): 7-13. DOI: 10.1097/00003086-200211000-00003. 
 
[21]GREEN G V, BEREND K R, BEREND M E, et al. The effects of varus tibial alignment on proximal tibial surface strain in total knee arthroplasty: The posteromedial hot spot[J]. J Arthroplasty, 2002, 17(8): 1033-1039. DOI: 10.1054/arth.2002.35796. 
 
[22]BONNER T J, EARDLEY W G P, PATTERSON P, et al. The effect of post-operative mechanical axis alignment on the survival of primary total knee replacements after a follow-up of 15 years[J]. J Bone Joint Surg Br, 2011, 93(9): 1217-1222. DOI: 10.1302/0301-620x.93b9.26573. 
 
[23]MORGAN S S, BONSHAHI A, PRADHAN N, et al. The influence of postoperative coronal alignment on revision surgery in total knee arthroplasty[J]. Int Orthop, 2008, 32(5): 639-642. DOI: 10.1007/s00264-007-0391-0. 
 
[24]RITTER M A, DAVIS K E, MEDING J B, et al. The effect of alignment and BMI on failure of total knee replacement[J]. J Bone Joint Surg Am, 2011, 93(17): 1588-1596. DOI: 10.2106/JBJS.J.00772. 
 
[25]DELPORT H, LABEY L, INNOCENTI B, et al. Restoration of constitutional alignment in TKA leads to more physiological strains in the collateral ligaments[J]. Knee Surg Sports Traumatol Arthrosc, 2015, 23(8): 2159-2169. DOI: 10.1007/s00167-014-2971-z. 
 
[26]VANLOMMEL L, VANLOMMEL J, CLAES S, et al. Slight undercorrection following total knee arthroplasty results in superior clinical outcomes in varus knees[J]. Knee Surg Sports Traumatol Arthrosc, 2013, 21(10): 2325-2330. DOI: 10.1007/s00167-013-2481-4. 
 
[27]SCHIFFNER E, WILD M, REGENBRECHT B, et al. Neutral or natural? functional impact of the coronal alignment in total knee arthroplasty[J]. J Knee Surg, 2019, 32(8): 820-824. DOI: 10.1055/s-0038-1669788. 
 
[28]MATZIOLIS G, ADAM J, PERKA C. Varus malalignment has no influence on clinical outcome in midterm follow-up after total knee replacement[J]. Arch Orthop Trauma Surg, 2010, 130(12): 1487-1491. DOI: 10.1007/s00402-010-1064-9. 

相似文献/References:

[1]何森,曹文,李刚,等.QS微创全膝关节置换术的早期疗效观察[J].陆军军医大学学报(原第三军医大学学报),2007,29(23):2283.
　HE Sen,CAO Wen,LI Gang,et al.Short-term clinical outcome of quadriceps sparing total knee arthroplasty[J].J Amry Med Univ (J Third Mil Med Univ),2007,29(22):2283.
[2]吴晓光,谢峰.全膝关节置换术后膝关节不稳定危险因素评估[J].陆军军医大学学报(原第三军医大学学报),2021,43(13):1263.
　WU Xiaoguang,XIE Feng.Risk factors for knee instability after total knee arthroplasty surgery[J].J Amry Med Univ (J Third Mil Med Univ),2021,43(22):1263.

更新日期/Last Update: 2021-11-23