Lateral Collateral Tightening for Residual Lateral Instability in Total Knee Arthroplasty

使用外側韌帶緊縮手術治療人工全膝關節置換時存餘之外側不穩定

敖曼冠(Man-Kuan Au)

《Journal of Orthopaedic Surgery Taiwan》 10卷3期 (1993/09) Pp. 299-308

摘要

自一九八九年七月至一九九二年十二月，本院共有七個連續並換，九個膝關節嚴重內翻畸形。在使用後十字韌帶保存式之全膝人工關節置換術治療時，當使用一般之手術步驟後，仍存餘有明顯之外側不穩定。此特殊狀況下，必須使用外側副韌帶在股骨附著點之骨塊(bone block)向前端及近端轉移才能矯治得到良好的軟組織平衡。病人平均經過二十四點二月之追蹤(10-40月)，在術中使用應力時膝關節產生內翻之角度平均為13.8度(10-20)，在使用緊縮手術後則無存餘之不穩定及畸形，於日後之追蹤檢查亦無結果惡化之現象。臨床之評估，膝評分由術前之42.8(35-52)進步到術後之92.4(89-95)。此特殊狀況極少文獻討論如何處理，而本院使用此法證實為一簡單安全有效之解決之道特提出報告。

並列摘要

Since July 1989 to Dec. 1992 there wer 7 consecutive cases with 9 knees with severe varus deformity. By using the PCL-retaining types of total knee prosthesis, there had significant residual lateral laxity after the standard procedure. Tightening of the lateral collater complex by transferring the bone block of its femoral insertion proximally and anteriorly had to be done for ligament re-balance. The average follow up period was 24.2 months (10-40 mons). The perioperative varus deformity under stress test was 13.8 degrees (10-20). After the procedure, there were no residual instability. No deterioration of the results was found in later follow up. The mean knee scores were improved from 42.8 (35-52) preoperatively to 92.4 (89-95) after the procedure of TKA and lateral collateral tightening. In our hand, the procedure had been proved to be a very simple, safe and effective method in dealing residual lateral laxity which may encounter in total knee arthroplasty.

並列關鍵字

Total knee replacement ； Severe varus knee ； Lateral collateral tightening ； Residual lateral unstable TKR