| 【Background and objective】Total knee arthroplasty(TKA) is an effective method to treat end-stage knee osteoarthritis(OA)and rheumatoidarthritis(RA),which can relieve pain,correct deformities,improve function and improve the quality of life of patients.Distal femoral osteotomy is an important procedure in TKA.Currently,the most widely used method of intramedullary localization osteotomy has some disadvantages and risks.The femoral extramedullary localization tool can avoid the disadvantages and risks of intramedullary localization osteotomy,but this method is rarely used nationwide,and the analysis and evaluation of the medium and long-term clinical efficacy of this method is still insufficient,which needs to be improved.In this paper,the clinical efficacy of the self-made femoral extramedullary localization tool applied to the primary TKA in the near and middle term was analyzed,so as to provide the basis for the application and promotion of the extramedullary localization osteotomy technology【Methods】This study retrospectively analyzed between September 2018 and April2019 line Yu Dali university first affiliated hospital during TKA patients clinical data,a total of 65 cases(72 knees),including 16 cases of male 18(knee)and female 49 cases(54 knees),OA 56 cases(63 knees),RA 9 cases(9knees),30 knees of minority nationalities,the han 42 knees,age 47-80,mean age,64.57 years;The average Body Mass Index(BMI)was 24.67±3.66kg/m2,including 12 obese patients(BMI≥28)(15 knees)and 53 non-obese patients(BMI<28)(57 knees).The surgeries were performed by the same surgeon,and posterior stable prosthesis was selected,including 18 knees of Johnson &Johnson(imported)knee prosthesis and 54 knees of Weigao(domestic)knee prosthesis.Antibiotics were applied before and after surgery to prevent infection,and scientific rehabilitation exercise of knee function was conducted after surgery.At 1,3,6,12 and 24 months after surgery,the anteroposterior and lateral knee joint,axial patella and full-length anteroposterior X-ray examination of lower extremities were performed before and after surgery.Recorded preoperatively and at the time of the last follow-up of patientswith knee joint HSS(Hospital for Special Surgery knee score)score(range of motion,ROM),hip,knee joint mobility knee ankle Angle(hip-knee-ankleangle,HKA).The occurrence of postoperative complica-tions was actively prevented and observed,and the satisfaction of the patients was evaluated at the last time.Paired t test was used for statistical analysis of preoperative and final follow-up data,and the clinical efficacy of self-made femoral extramedullary localization tool in the near and middle stage of primary TKA was analyzed.And discuss the patient’s gender,age,BMI,nationality,cause,type of prosthesis of the knee joint at the time of the last follow-up function to improve the degree of difference,the repetitive measure analysis of variance to evaluate the influence factors on the function of knee joint at the time of the last follow-up to improve the degree of difference,surgery using near the medial patellar road,release,balance of soft tissue,using the ligament balance technology precision TKA bone cutting is complete,has not been surgery patella replacement.【Results】All patients were followed up for an average of 18.22 months(12-24months).Compared with preoperative,knee HSS score,knee ROM and HKA Angle were significantly improved at the last follow-up,with statistical significance(P<0.05).There were no significant differences in the improvement of knee function at the last follow-up among different genders,ages,BMI,ethnic groups,etiology and prosthesis types,but the HSS scores in the non-obese group(BMI<28)before surgery and at the last follow-up were higher than those in the obese group(BMI≥28).The rate of excellent and good HSS score at the last follow-up was significantly higher than that before surgery,and the satisfaction was higher.During the follow-up period,no complications occurred,such as periprosthesis infection,loosening,thrombus,nerve injury,pain of unknown cause,etc.【Conclusion】The research results show that under the premise of strictly grasp the surgical indications and contraindications,self-made femoral bone marrow outside the localization tool applied in primary TKA treatment of end-stage knee OA and RA near,medium-term clinical curative effect is distinct,intraoperative use accurate personalized bone cutting,release,balance of soft tissue,can effectively correct lines of force of lower limb,postoperative can obviously relieve knee pain,improve the function of knee joint,patients’ age,sex,etiology,BMI,nationality,type of prosthesis for primary TKA surgery curative effect is not significant.All the 65 cases(72 knees)in this group achieved the expected treatment effect,the incidence of postoperative complications was low,the satisfaction of patients was high,and the quality of life of patients was greatly improved,which is worthy of promotion. |
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