膝内翻患者全膝关节置换术后保留轻度内翻对临床效果的影响

目的评价膝内翻患者全膝关节置换术后保留轻度内翻对临床效果的影响。方法对2016年3月至2019年11月于武汉大学人民医院因膝内翻膝关节骨性关节炎行TKA治疗的93例（93膝）患者的临床资料进行回顾性分析。其中，男17例，女76例；年龄71 ～ 87岁，平均77岁。按患者术后下肢力线角度将患者分为中立组、轻度内翻组、严重内翻组。用ROM、HSS、AKS评分量表评价患者膝关节功能。结果患者随访时间15 ～ 47个月，平均（24.4±8.9）个月，ROM术前平均（49.9±6.7）°，术后末次随访中立组、轻度内翻组、严重内翻组分别为平均（111.4±5.3）°、（112.2±5.0）°、（103.1±2.7）°，HSS评分术前平均（52.4±3.0）分，术后末次随访中立组、轻度内翻组、严重内翻组分别为平均（84.2±3.0）分、（87.1±2.6）分、（81.6±1.9）分，AKS功能评分术前平均（49.8±2.8）分，术后末次随访中立组、轻度内翻组、严重内翻组分别为平均（73.2±5.3）分、（80.1±3.0）分、（72.6±1.5）分，AKS活动评分术前平均（60.5±3.7）分，术后末次随访中立组、轻度内翻组、严重内翻组分别为平均（86.0±2.6）分、（89.9±2.0）分、（80.6±2.9）分，三组术后HSS、AKS评分均较术前有所提高，差异有统计学意义。结论从短期随访来看，膝内翻患者全膝关节置换术后保持3° ～ 6°的轻度内翻会带来更好的临床疗效，但目前还不能判断内翻对齐和翻修率之间是否存在关联。

英文摘要:

Objective To evaluate the clinical effect of remaining mild varus after total knee arthroplasty in patients with varus knee. Methods A retrospective analysis of the clinical data of 93 patients (93 knees) who underwent TKA treatment for knee varus in Renmin Hospital of Wuhan University from March 2016 to November 2019. Among them, there were 17 males and 76 females; the age ranged from 71 to 87 years, with an average of 77 years old. The patients were divided into neutral group, mild varus group, and severe varus group according to the angle of the lower limb force line after the operation. Evaluation of knee joint function of patients with ROM, HSS and AKS scales. Results Patients were followed up for 15 to 47 months, with an average of (24.4±8.9) months. The average preoperative ROM was (49.9±6.7) degrees. The ROM at the final follow-up after the operation was (111.4±5.3)°, (112.2±5.0)°, (103.1±2.7)° in the neutral group, mild varus group, and severe varus group, respectively. The average HSS score before surgery was (52.4±3.0) points, and the final follow-up postoperative follow-up for the neutral group, mild varus group, and severe varus group were (84.2±3.0) points,(87.1±2.6) points,(81.6±1.9) points respectively. The AKS function score preoperatively averaged (49.8±2.8) points, the last follow-up postoperatively, the neutral group, the mild varus group, and the severe varus group were average respectively (73.2±5.3) points, (80.1±3.0) points, (72.6±1.5) points. AKS activity scores averaged (60.5±3.7) points before surgery, at the last follow-up after operation, neutral group, mild varus group, severe varus groups were respectively (86.0±2.6) points, (89.9±2.0) points, (80.6±2.9) points. The scores of HSS, and AKS in the three groups after surgery were improved compared with those before surgery, and the difference was statistically significant. Conclusion From the short-term follow-up, maintaining a mild varus of 3°-6° after total knee arthroplasty in patients with varus will bring better clinical efficacy, but it is not yet to judge whether there is a relationship between varus alignment and revision rate.

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