Treatment of knee osteoarthritis associated with extraarticular varus deformity of the femur: staged total knee arthroplasty following corrective osteotomy
Treatment of knee osteoarthritis associated with extraarticular varus deformity of the femur: staged total knee arthroplasty following corrective osteotomy
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DOI：
10.1007/s00776-006-1035-8
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发表时间：
2006-07-01
影响因子：
1.7
通讯作者：
Yasui, Natsuo
中科院分区：
文献类型：
--
作者：
Yagi, Keisuke;Matsui, Yoshito;Yasui, Natsuo
考虑到患者的症状和年龄，建议采用TKA。最初，为了获得股骨的正常对齐，在畸形顶点处进行外侧闭合楔形截骨术。角形畸形矫正后，用临时Ilizarov外固定架和锁定钢板（Mathys）固定截骨部位。术后x线片显示股骨内翻畸形减轻，左下肢机械轴向膝关节中心内侧延伸25mm（图4）。截骨5个月后，骨愈合，硬件被移除。尽管疼痛略有减轻，但患者能够行走的距离受到剩余严重骨关节炎的限制（图5）。4个月后，使用后路稳定假体进行骨水泥TKA。术前膝关节社会评分和功能评分分别为6分和10分。膝关节外露采用常规内侧髌旁入路。由于股四头肌肌腱僵硬和股内侧肌因初始创伤而愈合，髌骨无法外翻。然后用股四头肌剪进行伸展暴露。紧的内侧副韧带复合体需要释放远侧内侧副韧带以达到满意的软组织平衡。先前的矫正截骨术并不排除需要髓内股骨切割导具。没有必要去掉多余的
In view of the patient’s symptoms and age, TKA was indicated. Initially, to obtain normal alignment of the femur, lateral closed-wedge osteotomy was performed at the apex of the deformity. After correction of the angular deformity, the site of osteotomy was fixed with a temporary Ilizarov external fixator and a locking plate (Mathys). Postoperative radiographs showed that the varus deformity of the femur was reduced, and the mechanical axis of the left lower extremity ran 25mm medial to the center of the knee (Fig. 4). Five months after the osteotomy, osseous union occurred, and the hardware was removed. Although the pain was slightly reduced, the distance the patient was able to walk was restricted by the remaining severe osteoarthritis (Fig. 5). Four months later, cemented TKA was performed using a posterior-stabilized prosthesis. Preoperatively, the Knee Society Knee Score and Function Score were 6 and 10 points, respectively. Exposure of the knee joint was performed by a conventional medial parapatellar approach. The patella was unable to be everted because of the stiffness of the quadriceps tendon and cicatrization of the vastus medialis muscle by the initial trauma. Extensile exposure with a quadriceps snip was then performed. A tight medial collateral complex required release of the distal medial collateral ligament to achieve satisfactory soft tissue balance. Prior corrective osteotomy did not preclude the need for an intramedullary femoral cutting guide. It was not necessary to remove an excessive