全膝关节置换术中胫骨后倾截骨角度对患者术后关节活动度和功能的影响

摘要

Objective To investigate the effects of different posterior tibial osteotomy inclination angles on postopera -tive range of motion and function in patients after total knee arthroplasty .Methods Totally 101 cases of patients undergo-ing total knee arthroplasty were selected , including 50 cases used 5°posterior tibial osteotomy inclination angle ( observa-tion group) and 51 cases used that of 0°(control group).The patients in the two groups received the calf standard X-ray examination positively and laterally before and 6 months after surgery , then we measured the tibial angle , tilt angle after tibia, knee joint line height , maximum knee extension and flexion angles .The knee joint HSS score of the two groups was recorded before and at 4, 12 weeks of treatment and the complications after 6-month treamtment.Results The tibia angle, joint line height and maximum extension angle of the two groups after 6-month treamtment were decreased as compared with those before treatment .The posterior tibial slope angle , maximum flexion angle were all increased , and HSS scores were in-creased after 4 and 12 weeks of treatment .The above changes of the observation group were more significant than those of the control group (all P<0.01).The incidence of complications such as tibial plateau backward , shift down of patellar tendon, delayed fracture healing and severe abrasion of implant in the observation group was lower than that of the control group (all P<0.05).Conclusion During total knee arthroplasty, using 5°posterior tibial osteotomy inclination angle can improve the postoperative range of motion and function in patients after surgery , and its efficacy and safety is better than that of 0°.%目的：探讨不同胫骨后倾截骨角度对患者全膝关节置换术后关节活动度及功能的影响。方法选择行全膝关节置换术的患者101例，其中术中胫骨后倾截骨角度为5°者50例（观察组），胫骨后倾截骨角度为0°者51例（对照组）。两组治疗前及治疗6个月行小腿标准正侧位X线检查，测量胫骨角、胫骨后倾角度、膝关节关节线高度、膝关节最大伸直和屈曲角度。记录两组治疗前及治疗4、12周的膝关节HSS评分，以及治疗6个月并发症发生情况。结果与治疗前比较，两组治疗6个月胫骨角、膝关节关节线高度、膝关节最大伸直角度均降低，胫骨后倾角度、膝关节最大屈曲角度均升高；治疗4、12周膝关节HSS评分均升高；观察组上述指标变化更明显， P均＜0．01。观察组胫骨平台后倾、髌腱止点下移、骨折愈合延迟、假体严重磨损等并发症发生率均低于对照组，P均＜0．05。结论全膝关节置换术中采用5°胫骨后倾截骨有利于提高患者术后的关节活动度及功能，其效果及安全性优于0°胫骨后倾截骨。