- 期刊
Total Knee Arthroplasty for Knee Arthritis with Valgus Deformity through the Midvastus Approach
採用股四頭肌中段內側切開術之人工膝關節治療外翻性退化性膝關節炎臨床的結果
並列摘要
Purpose: Our objective was to evaluate clinical outcomes and lateral retinacular release after total knee arthroplasty (TKA) with a midvastus approach to treat valgus. Methods: Over 2 years, 598 posterior-stabilized TKA s were performed with a midvastus approach. Sixty (10%) knees had anatomic tibiofemoral valgus alignment of 10° or greater. Preoperative diagnoses were osteoarthritis in 49 knees, rheumatoid arthritis in 8, traumatic arthritis in 2 and osteonecrosis in 1. Mean preoperative valgus deformity was 18°. Mean preoperative range of motion was 6° extension and 118° flexion. Posterolateral corner and lateral capsular release with appropriate medial release was routinely performed without further release of the lateral collateral ligament, popliteal tendon and iliotibial band. Results: Twenty (33%) knees had preoperative patellar subluxation ＞ 16° and tilting ＞ 5° and/or lateral displacement ＞ 5 mm. Displacement ＞ 5 mm or ＞ 5° tilting was considered abnormal (5 knees subluxed, 15 abnormal). Mean follow-up was 29 months. Tibiofemoral alignment averaged 6°. Postoperative alignment was significantly corrected (P＜0.001). Lateral retinacular release was done in 11 knees (18%) because of poor intraoperative patellar tracking (overall incidence, 10 [1.8%] of 538). Mean postoperative ranges of motion were 0° extension and 126° flexion. At last follow-up, all knees had good patellar tracking on radiographs. No immediate complications (eg, infection, peroneal nerve palsy) were noted. No revision surgery was performed. Conclusion: The midvastus approach was reliable in TKA to treat arthritis with valgus deformity. Improved short-term results and a reduced need for lateral retinacular release were achieved with appropriate soft-tissue balancing and bony cutting.
延伸閱讀
- Au, M. K. (1993). 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. Journal of Orthopaedic Surgery Taiwan, 10(3), 299-308. https://www.airitilibrary.com/Article/Detail?DocID=10116923-199309-10-3-299-308-a
- Wang, S. F., Lin, J. J., Jan, M. H., Cheng, C. K., & Liu, T. K. (1995). 單側退化性膝關節炎病人經全人工關節置換手術之肌力評估－初步報告. 中華民國物理治療學會雜誌, 20(2), 91-101. https://doi.org/10.29616/JPTAROC.199509.0001
- Ou, K. W., Wei, L. G., Chen, S. I., & Chen, S. G. (2012). 以反向大腿前外側皮瓣治療人工關節暴露之膝部感染性傷口－病例報告及文獻回顧. 臺灣整形外科醫學會雜誌, 21(2), 158-163. https://doi.org/10.7096/TJTSPS.201206.0158
- Yu, C. T., Hsieh, Y. Z., Yeh, L. T., Hung, T. H., Chang, C. C., Hsieh, C. P., Chen, S. J., Hung, R. K., Wu, R. K., Chang, I. L., & Sh (2007). 全人工膝關節置換術後併發反射性交感神經失養症：一病例報告及文獻回顧. Journal of Orthopaedic Surgery Taiwan, 24(4), 147-150. https://www.airitilibrary.com/Article/Detail?DocID=10116923-200712-24-4-147-150-a
- Ni, T. S., Chang, S. H., Huang, T. Y., Hsiao, H. T., & Tung, K. Y. (2010). 膝部惡性腫瘤切除後以大腿前外側皮膚及筋膜複合式自由皮瓣重建膝關節伸展功能之病例報告. 台灣癌症醫學雜誌, 26(1), 37-42. https://doi.org/10.6323/JoCRP.2010.26.1.6