内翻膝行全膝关节置换术对踝关节及后足力线的影响

Effect of Total Knee Arthroplasty on AnkleJoint and Posterior Foot Line after VarusKnee

摘要: 目的：探讨内翻膝行全膝关节置换术后对踝关节及后足力线的影响。方法：回顾性选取自2020年8月至2021年1月青岛大学附属医院关节外科收治的81例行单侧全膝关节置换术的内翻型膝关节骨性关节炎患者，术前及术后均拍摄负重位的下肢全长X线片、后足长轴位X线片及踝关节侧位X线片。并记录所有患者术前及术后6个月踝关节是否疼痛。测量患者术前及术后的髋–膝–踝角、后足力线角度及胫骨跟骨角度。根据后足力线角度和踝关节症状分别进行分组分析。结果：81例患者术后6个月HKA角明显改善，由12.48˚ ± 4.72˚调整至3.34˚ ± 1.50˚，后足力线角度从5.31˚ ± 5.89调整到4.41˚ ± 4.33˚，胫骨跟骨角度从66.99˚ ± 6.99˚调整到65.64˚ ± 5.49˚，差异均具有明显统计学意义(P < 0.001)。分组：后足外翻组和后足内翻组患者术前年龄、BMI、HKA角度、后足力线角度及胫骨跟骨角度比较差异无统计学意义(P > 0.05)。踝关节发病率在TKA术前为11.1%，在TKA术后为13.6%，差异无统计学意义(P > 0.05)。踝关节有症状组和踝关节无症状组术前年龄、BMI、HKA角度、胫骨跟骨角和后足力线角度无统计学差异(P > 0.05)。结论：膝内翻患者行TKA后其HKA角度、后足力线角度和胫骨跟骨角度都会得到相应改变，且均趋向于减小。踝关节疼痛的发病率术前术后无明显变化。因此，我们建议在对膝内翻OA准备TKA手术时，除了常规的膝关节的术前检查，还要对足及踝关节进行全面的术前评估；术后除了膝关节的功能恢复，还要加强踝关节的术后管理，必要时尽早对踝关节进行治疗或干预。

Abstract: Objective: To investigate the effect of total knee arthroplasty on ankle joint and foot line after varus knee. Methods: Retrospectively select 81 patients with inverted knee osteoarthritis who underwent unilateral total knee arthroplasty from August 2020 to January 2021 in the Department of Joint Surgery of the Affiliated Hospital of Qingdao University, and take full-length X-rays of the lower extremities, X-rays of the posterior foot length axis and lateral X-rays of the ankle joint before and after the operation. All patients were recorded for ankle pain before surgery and 6 months after surgery. Preoperative and postoperative hip-knee-ankle angle, posterior foot line angle and tibial calcaneal angle were measured. Group analysis was performed according to the Angle of rear foot line and ankle joint symptoms. Result: The HKA angle of 81 patients was significantly improved 6 months after operation, from 12.48˚ ± 4.72˚ to 3.34˚ ± 1.50˚, the angle of rear foot line was adjusted from 5.31˚ ± 5.89˚ to 4.41˚ ± 4.33˚, and the angle of tibial calcaneal bone was adjusted from 66.99˚ ± 6.99˚ to 65.64˚ ± 5.49˚. The differences were statistically significant (P < 0.001). Grouping: There were no significant differences in preoperative age, BMI, HKA angle, posterior foot force line angle and tibial calcaneal angle between the varus group and the varus group (P > 0.05). The incidence of ankle joint was 11.1% before TKA and 13.6% after TKA, with no significant difference (P > 0.05). There were no statistically significant differences in preoperative age, BMI, HKA angle, tibial calcaneal angle and posterior foot force line angle between symptomatic and asymptomatic ankle groups (P > 0.05). Conclusion: After TKA, HKA angle, rear foot line Angle and tibial calcaneal angle of patients with genu varus were all changed, and tended to decrease. The incidence of ankle pain had no significant change before and after operation. Therefore, we recommend that in preparation for TKA surgery for knee varus OA, in addition to the routine preoperative examination of the knee joint, a comprehensive preoperative assessment of the foot and ankle joint should be carried out; in addition to the functional recovery of the knee joint, the postoperative management of the ankle joint should be strengthened, and the ankle joint should be treated or intervened as soon as possible if necessary.