膝内翻骨关节炎TKA后下肢力线矫正对早期膝功能影响

Effect of Lower Limb Force Line Correction on Early Knee Function after TKA for Varus Knee Osteoarthritis

摘要: 目的：探讨膝内翻畸形骨关节炎患者TKA后下肢力线矫正对早期膝关节功能的影响，为术中矫正提供依据。方法：回顾分析2022年1月至2023年8月巴州地区人民医院60例膝内翻骨关节炎行TKA患者。测术前术后HKA角，获HSS评分及ROM。按术后HKA分为中立组、轻度内翻组、重度内翻组，比较各组术前术后HSS及ROM差异。结果：所有患者手术顺利，所有患者术后至末次随访均无感染、血栓脱落、假体问题、骨折、关节僵硬等并发症及不良结局。所有患者的HKA角术前168.01˚ ± 1.63˚，术后179.24˚ ± 1.39˚，术前术后有差异(P < 0.001)；ROM角术前85.19˚ ± 2.69˚，术后113.23˚ ± 2.67˚，术前术后有差异(P < 0.001)；HSS评分术前63.67 ± 1.76，术后88.02 ± 1.27，术前术后有差异(P < 0.001)；术前比较术后均有显著性差异，可见明显改善(P < 0.001)。与重度残余内翻组相比，轻度残余内翻组和中立组在术后HKA角度、ROM和HSS评分上均表现出更优的恢复效果。结论：TKA可改善内翻畸形膝骨关节炎患者的下肢力线和早期功能。本研究结果显示，重度残余内翻组比，轻度残余内翻组和中立组在术后HKA、ROM和HSS评分上恢复更佳。

Abstract: Objective: To investigate the effect of lower limb force line correction on early knee function, and to provide a basis for intraoperative correction. Methods: 60 patients from January 2022 to August 2023. The preoperative and postoperative HKA angle was measured, and the HSS score and ROM were obtained. The difference in postoperative HSS and ROM was compared according to postoperative HKA in neutral, mild varus, and severe varus. Results: All patients underwent successful surgery. From the postoperative period to the last follow-up, no complications or adverse outcomes such as infection, thrombus detachment, prosthesis problems, fracture, or joint stiffness were observed in any patient. The preoperative HKA (hip-knee-ankle) angle was 168.01˚ ± 1.63˚, which improved to 179.24˚ ± 1.39˚ postoperatively, with a significant difference between pre- and postoperative values (P < 0.001). The ROM (range of motion) angle increased from 85.19˚ ± 2.69˚ preoperatively to 113.23˚ ± 2.67˚ postoperatively, also showing a significant difference (P < 0.001). The preoperative HSS (Hospital for Special Surgery) score was 63.67 ± 1.76, which improved to 88.02 ± 1.27 postoperatively, with a significant difference (P < 0.001). All these parameters showed significant improvements postoperatively compared to preoperatively (P < 0.001). Compared with the severe residual varus group, the mild residual varus group and the neutral group exhibited better recovery in terms of postoperative HKA angle, ROM, and HSS scores. Conclusion: TKA can improve the force line and early function in patients with varus deformity. The results of this study showed that in the severe residual varus group ratio, the mild residual varus group and the neutral groups showed better recovery in postoperative HKA, ROM and HSS scores.