膝内翻畸形程度对全膝关节置换术的影响△（开放获取）

Impact of preoperative knee varus deformity on total knee arthroplasty

摘要:

[目的] 探讨膝内翻畸形程度对全膝关节置换术 （total knee arthroplasty, TKA） 疗效的影响。[方法] 回顾性分析 2020 年 4 月—2022 年 4 月 86 例在本院行 TKA 的膝骨关节炎患者的临床资料。根据术前髋-膝-踝角 （hip-knee-ankle angle, HKAA），54 例为轻度内翻（≤10°），32 例为中度内翻畸形（10°~20°）。分析下肢力线与临床评分的相关性。[结果]两组均顺利手术，无严重并发症，两组间围手术期指标的差异均无统计学意义（P＞0.05）。随时间推移，两组术后 VAS 评分、WOMAC 评分、膝伸-屈 ROM 及 HSS 评分均显著改善（P＜0.05）。术前及术后 3 个月轻度组 VAS、HSS、WOMAC 及膝伸-屈 ROM 均显著优于中度组（P＜0.05）。影像方面，轻度组术前股胫角（femorotibial angle, FTA） [(190.4±5.6)° vs (196.3±6.1)°, P＜0.001]、胫骨近端内侧角 （medial proximal tibial angle, MPTA） [(73.4±3.8)° vs (67.2±3.1)°, P＜0.001] 、胫骨平台后倾角 （posterior tibial slope, PTS） [(8.5±1.9)° vs (7.2±1.6)°, P=0.002]、机械轴偏移（mechanical axis deviation, MAD） [(38.4±1.5) mm vs (40.6±2.1)mm, P=0.002] 均显著优于中度组。末次随访时，轻度组的 FTA [(174.3±4.1)° vs (180.7±5.3)°, P＜0.001]、MPTA [(87.6±5.3)° vs (79.3±4.5)°, P＜0.001] 显著优于中度组（P＜0.05），但两组间 PTS、MAD 的差异无统计学意义（P＞0.05）。Pearson 相关性分析显示，术前 FTA 与 VAS 评分 （r=0.416, P=0.014）、WOMAC 评分（r=0.545, P＜0.001）呈显著正相关，与 ROM 呈显著负相关（r=-0.545, P＜0.001）；术前 MPTA 与 VAS 评分 （r=-0.452, P=0.008）、WOMAC 评分 （r=-0.578, P＜0.001） 呈显著负相关，与 ROM 呈显著正相关 （r=0.614, P＜ 0.001）。末次随访 FTA、MPTA 与 VAS 评分、WOMAC 评分、ROM 均无显著相关性（P＞0.05）。[结论] 术前膝内翻畸形程度对 TKA 术后下肢力线影响显著，但对膝关节活动度、膝关节功能的影响较小。

Abstract:

[Objective] To investigate the effect of preoperative knee varus deformity on the outcomes of total knee arthroplasty (TKA). [Methods] A retrospective study was conducted on 86 patients who received TKA for knee osteoarthritis in our hospital from April 2020 to April 2022. According to the preoperative hip-knee-ankle angle (HKAA), 54 patients had mild knee varus (≤10°), while the remaining 32 patients had moderate knee varus deformity (10°~20°). The correlation between lower limb alignment and clinical score was analyzed. [Results] All patients in both groups had TKA performed successfully without serious complications, and with no significant differences regarding perioperative data between the two groups (P＞0.05). The VAS, WOMAC and HSS scores, as well as knee extension-flexion ROM significantly improved in both groups over time postoperatively (P＜0.05). The mild group proved significantly better than the moderate group in terms VAS, WOMAC and HSS scores, as well as knee extension-flexion ROM before operation and 3 months postoperatively (P＜0.05). Radiographically, the mild group proved significantly superior to the moderate group in terms of femorotibial angle (FTA) [(190.4±5.6)° vs (196.3±6.1)°, P＜ 0.001], medial proximal tibial angle (MPTA) [(73.4±3.8)° vs (67.2±3.1)°, P＜0.001], posterior tibial slope (PTS) [(8.5±1.9)° vs (7.2±1.6)°, P= 0.002], mechanical axis deviation (MAD) [(38.4±1.5) mm vs (40.6±2.1) mm, P=0.002] before TKA; additionally FTA [(174.3±4.1)° vs (180.7± 5.3)°, P＜0.001], MPTA [(87.6±5.3)° vs (79.3±4.5)°, P＜0.001] regardless of that there was no significant difference in PTS and MAD between the two groups (P＞0.05) postoperatively. As results of Pearson correlation analysis, preoperative FTA was significantly positively correlated to VAS scores (r=0.416, P=0.014) and WOMAC scores (r=0.545, P＜0.001), whereas negatively correlated with ROM (r=-0.545, P＜0.001). In addition, the preoperative MPTA was significantly negatively correlated to VAS scores (r=-0.452, P=0.008) and WOMAC scores (r=-0.578, P＜0.001), whereas significantly positively correlated to ROM (r=0.614, P＜0.001). However, there were no correlation between FTA, or MPTA with VAS, WOMAC score and ROM at the last follow-up (P＞0.05). [Conclusion] The extent of knee varus deformity before surgery has considerable effect on the lower limb alignment after TKA, but has little effect on knee joint motion and knee function.