全膝关节置换术中股骨外侧髁滑移截骨矫正固定性膝外翻畸形的疗效观察

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Abstract Objective To observe the clinical effect of sliding osteotomy of lateral femur condyle for correcting fixed valgus deformity in primary total knee arthroplasty (TKA).Methods From May 2017 to June 2020，15 patients (17 knees)with Fixed valgus knees deformity including 5 men(5 knees)and 10 women(12 knees)underwent primary total knee arthmplasty.Average age was 69.5 years(range 59~76 years).The average weight was 73.6 kg(range 64.5~89.0 kg)and average body height was 170.5 cm(range 156~178 cm).The diagnoses of the patients were osteoarthritis in 13 cases(15 knees)and rheumatoid arthritis in 2 cases(2 knees).All patients were rated as type Ⅱ according to Krackow classification of valgus knee.During primary TKA，sliding osteotomy lateral femoral condyle for restoring soft tissue balance and correcting valgus deformity were performed via a medial parapatellar approach.Posterior stabilized prosthesis was employed in all cases.Properative and postoperative imaging parameters and clinical outcomes were evaluated.Results Average followup was 30.5 months(range 3~50 months).The tibiofemoral angle was corrected from preoperative (199.5±3.3)° to postoperative (172.4±1.5)°(P＜0.05).The femoral transepicondylar angle (FTEA) was significant improved from preoperative (80.3±1.7)°to postoperative (89.5±1.5)° (P＜0.05).According to knee society score(KSS) criterion.The clinical score improved from preoperative (33.2±6.5) to postoperative (89.1±1.2) and the functional score improved from (41.9±7.5) to (82.3±5.1)，the range of movement increased from preoperative (62.0±10.1)° before surgery to postoperative (115.0±10.7)°.There was significant statistic difference(P＜0.05).At the last follow-up，the X-ray showed that the position of the prosthesis was good，patella dislocation was not detected and complete union was found at the osteotomy site.The clinical mediolateral instability was not detected.Conclusion Sliding osteotomy of lateral femur condyle is safe and effective for correcting fixed valgus deformity in primary TKA.Restoration of lower limb alignment and balance soft tissue may be achieved with satisfactory clinical outcomes.

Key words： valgus deformity total knee arthroplasty sliding osteotomy

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