膝外翻患者外侧入路膝关节置换并髌骨置换对髌骨轨迹及膝前痛的影响

Influence on patellar tracking and anterior pain of valgus knees treated with lateral approach knee arthroplasty and patella replacement

目的对外翻膝患者行外侧入路膝关节置换术并髌骨置换,分析髌骨置换对其术后髌骨轨迹及膝前痛的影响。方法回顾性分析2014年1月至2016年1月膝外翻行全膝关节置换术患者临床资料,共34例(35膝),其中男11例(11膝),女23例(24膝),平均年龄(63.6±7.4)岁,对所有患者进行随访,通过比较术前与术后股胫关节外翻角、髌骨外侧倾斜角、髌股外移角、髌骨评分以及HSS评分、膝关节活动度、膝前痛发生率进行疗效评价。计量资料采用t检验进行统计分析,计数资料采用χ2检验进行分析比较。结果 34例均获12~36个月随访,平均22.4个月。股胫关节外翻角:术前(21.46±8.15)°,术后(6.11±1.05)°;髌骨外侧倾斜角:术前(8.94±2.95)°,术后(4.11±0.93)°;髌骨外移角:术前(12.54±5.99)°,术后(4.17±2.02)°;髌骨评分:术前(14.23±3.44)分,术后(24.89±2.91)分;HSS评分:术前(42.31±11.11)分,术后(83.14±6.25)分;膝关节活动度:术前(81.20±17.47)°,术后(100.94±8.27)°;膝前疼痛发生率:术前54.3%,术后5.7%。患者术前与术后股胫关节外翻角、髌骨外侧倾斜角、髌股外移角、髌骨评分、HSS评分、膝关节活动度、膝前痛发生率差异有统计学意义(P<0.05)。结论外翻膝患者行髌旁外侧入路膝关节置换并髌骨置换,可明显改善患者髌骨轨迹,提高膝关节屈曲活动度,减少膝前痛发生率。

Objective Patients with valgus knees were treated with lateral approach knee arthroplasty and patella replacement. To analyze the influence of patellar replacement on anterior knee pain and patella tracking after operation. Methods Clinical data of valgus knee patients after total knee arthroplasty from January 2014 to January 2016 were retrospectively analyzed. There were 34 patients with 35 knees, including 11 males and 23 females. The mean age was( 63.6 ± 7.4) years. Preoperative and postoperative femoro-tibia valgus angle, patellar tilt angle, patellar displacement angle, patellar score, HSS score, knee range of motion, and anterior knee pain incidence were compared and evaluated. Measurement data were analyzed by t test and the counting data were analyzed and compared by chisquare test. Results Total of 34 patients were followed up with an average of 22.4 months( range: 12-36 months). Femoro-tibia valgus angle:( 21.46 ± 8.15) ° preoperatively;( 6.11 ± 1.05) ° postoperatively. Patellar tilt angle:( 8.94 ± 2.95) ° preoperatively;( 4.11 ± 0.93) ° postoperatively. Patellar displacement angle:( 12.54 ± 5.99) ° preoperatively;( 6.11 ± 1.05) ° postoperatively. Patellar score:( 14.23 ± 3.44) preoperatively;( 24.89 ± 2.91) postoperatively. HSS score:( 42.31 ± 11.11) preoperatively;( 83.14 ± 6.25) postoperatively. Knee range of motion:( 81.20 ± 17.47) ° preoperatively;( 100.94 ± 8.27) ° postoperatively. The incidence of anterior knee pain: 54.3% preoperatively;5.7% postoperatively. There were significant differences between preoperative and postoperative femoro-tibia valgus angles, patellar tilt angles, patellar displacement angles, patellar scores, HSS scores, knee range of motion, and anterior knee pain incidences( P < 0.05). Conclusions Lateral approach knee arthroplasty and patella replacement can significantly improve the patellar tracking, knee range of motion and reduce the incidence of anterior knee pain in the treatment of valgus knees.