全膝关节置换术治疗膝内翻畸形的中期效果分析

Analysis of the mid-term effect of total knee arthroplasty with different Krackow classification

摘要:

目的 探讨不同Krackow分型膝内翻畸形患者行全膝关节置换术（TKA）的中期效果。方法 选取聊城市中医医院2017年1月—2019年1月收治的膝关节内翻畸形患者80例作为研究对象，共98膝。根据改良版Krackow分型将80例患者的膝内翻膝关节分为Ⅰ型34例（40膝）、Ⅱ型26例（36膝）、Ⅲ型20例（22膝）。所有患者均接受TKA，比较不同Krackow分型患者手术前后的内翻角度、膝关节活动度及HSS评分；比较各组患者术后随访24个月的并发症发生情况。结果 手术前Ⅰ型、Ⅱ型、Ⅲ型3组患者内翻角度、HSS评分比较，差异有统计学意义（P <0.05）；膝关节活动度比较，差异无统计学意义（P >0.05）。手术后不同分型患者内翻角度、HSS评分及膝关节活动度较术前均得到改善（P <0.05）；且I型患者内翻角度、HSS评分、膝关节活动度高于Ⅱ型、Ⅲ型患者（P <0.05），Ⅱ型患者内翻角度、HSS评分、膝关节活动度高于Ⅲ型患者（P <0.05）。3组不同分型患者术后均未出现严重并发症，仅Ⅱ型和Ⅲ型患者中各有1例在TKA术后发生感染，其余患者未发生血栓、关节腔积血等严重并发症，3组患者并发症发生情况比较，差异无统计学意义（P >0.05）。结论 TKA治疗不同Krackow分型的膝内翻畸形均有良好效果，可改善患者内翻角度、HSS评分及膝关节活动度，应及早进行手术干预治疗。

Abstract:

Objective To investigate and study the mid-term effects of total knee arthroplasty in patients with different Krackow classification knee varus.Methods Eighty patients with knee varus deformity admitted to our hospital from January 2014 to June 2016 were selected as subjects. According to the modified Krackow classification, 98 cases of knee varus were divided into 34 cases (40 knees) of type I, 26 cases (36 knees) of type II, and 20 cases (22 knees) of type III. All patients underwent total knee arthroplasty. The varus angles, knee mobility and HSS scores before and after surgery were compared between different Krackow patients. At the same time, the complications of patients in each group were followed up for 24 months..Results The results of this study showed that the varus angle and HSS scores of patients with type I, type II, and type III before surgery were statistically different (P < 0.05), and there was no significant difference in knee joint mobility (P > 0.05). The varus angle, HSS score, and knee joint activity of patients with different classifications after operation were significantly improved compared with preoperative (P < 0.05). The type of varus angle, HSS score, and knee joint activity of type I patients were higher than those of type II and type III patients. The above indexes of type II patients were higher than those of type III patients, and the differences were statistically significant (P < 0.05). There were no serious complications in the three groups of patients with different types of classification. Only one of the patients with type II and type III had infection after TKA, and the other patients had no serious complications such as thrombosis and joint blood. There was no significant difference in the incidence of complications between the three groups (P > 0.05).Conclusion Total knee arthroplasty has good effects in the treatment of knee varus deformities with different Krackow classifications, which can significantly improve knee joint mobility, varus angle, and HSS score. However, there is a negative correlation between the degree of improvement in prognosis and the degree of preoperative varus and typing. Surgical intervention should be performed as soon as possible.