【摘要】：目的評估改良Pie-crusting技術(shù)(簡稱PC技術(shù))在初次全膝關(guān)節(jié)置換術(shù)(total knee arthroplasty,TKA)內(nèi)側(cè)松解中應(yīng)用的安全性和有效性。方法 2014年3月~2016年6月由同一術(shù)者采用改良PC技術(shù)完成膝內(nèi)翻畸形初次TKA 30例(34膝)。使用特制帶弧形刀柄限寬3 mm、限深5 mm的手術(shù)刀進行橫行點戳,以緊張部位優(yōu)先松解的原則,伸直緊時松解內(nèi)側(cè)副韌帶淺層后束纖維及后內(nèi)側(cè)關(guān)節(jié)囊,屈曲緊時松解內(nèi)側(cè)副韌帶淺層前束纖維。記錄松解前后伸直、屈曲位內(nèi)外側(cè)間隙值;根據(jù)術(shù)中測量值分為伸直屈曲均緊張組(10膝)、僅伸直緊張組(13膝)和僅屈曲緊張組(11膝),間隙≤1 mm為軟組織平衡,分別計算平衡矯正率。術(shù)后定期拍攝患膝負重位片測量下肢力線,記錄膝關(guān)節(jié)活動度(range of motion,ROM)、HSS評分、WOMAC評分,并與術(shù)前比較。結(jié)果 31膝達到屈伸間隙、內(nèi)外側(cè)間隙平衡。1膝伸直間隙內(nèi)外側(cè)相差2 mm,2膝屈曲間隙內(nèi)外側(cè)相差2 mm,總體平衡矯正率91.2%(31/34)。3例術(shù)中應(yīng)用限制性墊片。未發(fā)生因該技術(shù)導(dǎo)致的其他并發(fā)癥。僅伸直緊組松解后屈曲間隙增加中位數(shù)1 mm(1~3 mm),僅屈曲緊組松解后伸直間隙增加中位數(shù)1 mm(1~2 mm),無統(tǒng)計學(xué)差異(Z=-1.118,P=0.264)。術(shù)前患者膝關(guān)節(jié)ROM為83.3°±14.7°,機械軸偏移角度中位數(shù)11.5°(7°~32°),HSS評分為(42.7±16.3)分、WOMAC評分為(76.2±8.2)分,術(shù)后膝關(guān)節(jié)ROM為100.7°±14.2°(t=-7.714,P=0.000)、機械軸偏移角度中位數(shù)1°(0°~4°)(Z=-5.092,P=0.000)、HSS評分(88.1±9.9)分(t=-21.868,P=0.000)、WOMAC評分(11.4±9.7)分(t=31.726,P=0.000),均較術(shù)前明顯改善。結(jié)論在初次TKA中使用改良PC技術(shù)做內(nèi)側(cè)松解是安全、有效的。僅松解伸直或屈曲位觸摸緊張的纖維,也會同時影響兩個間隙。
[Abstract]:Objective to evaluate the safety and effectiveness of modified Pie-crusting technique (PC technique) in medial release of primary total knee arthroplasty (total knee arthroplasty,TKA). Methods from March 2014 to June 2016, 30 cases (34 knees) of primary TKA of knee varus deformity were performed by modified PC technique. A special scalpel with arc handle limited width of 3 mm, and depth of 5 mm was used to poke the transverse point. According to the principle of first release of tension part, the superficial posterior bundle fiber of medial collateral ligament and posterior medial joint capsule were loosened when stretching and tight, and the superficial anterior bundle fiber of medial collateral ligament was loosened when flexion was tight. According to the measured values, the tension group (10 knees), only flexion tension group (13 knees) and flexion tension group (11 knees) were divided into two groups, and the balance correction rate was calculated according to the measured values before and after loosening, which were divided into three groups: stretching tension group (13 knees) and flexion tension group (11 knees). The balance correction rate was calculated respectively. The force line of lower extremity was measured by regular knee weight film after operation, and the (range of motion,ROM), HSS score and WOMAC score of knee joint motion were recorded and compared with those before operation. Results 31 knees reached flexion and extension space, and the internal and external space was balanced. 1 the difference between medial and lateral flexion space was 2 mm,2, and the overall balance correction rate was 91.2% (31 鈮，

本文編號：2515071