全膝关节表面置换术并髌骨周围去神经对膝前区疼痛及髌骨运动轨迹的影响

Effect of total knee replacement and reserving patella with denervation on anterior knee pain and patellar motion trace

目的:回顾性分析全膝关节置换术(totalkneearthroplasty,TKA)保留髌骨并行髌骨周围去神经后对膝前区疼痛及髌骨运动轨迹影响的疗效,为临床治疗提供参考。方法:1999-12/2003-12在解放军总医院骨科住院治疗的膝关节骨性关节炎及类风湿性关节炎行人工全膝关节表面置换术,并在术中保留髌骨去神经患者182例(304膝),其中男41例,女141例,年龄45～81岁,骨关节炎196膝,类风湿性关节炎108膝。髌骨周围去神经处理包括:去除髌骨周围所有骨赘,磨平边缘,恢复髌骨原有解剖形态,用电刀切除髌骨周围软组织,部分去除髌骨神经支配,修整髌骨关节面使其光整平滑,试模复位后无拇指试验nothumbtest阳性者松解髌骨支持带。膝关节评分采用美国HSS评分系统,髌骨评分采用Feller等评分标准,随访时调查膝前区疼痛,拍摄膝关节正、侧及髌骨30°,90°轴位X射线片。结果:患者手术前后HSS评分分别为(38.3±16.7)和(86.3±11.3)分;髌骨评分分别为(15.6±5.7)和(25.8±3.0)分;膝前痛评分分别为(6.5±4.6)和(12.3±2.7)分;髌骨功能评分分别为(5.6±2.8)和(8.6±1.4)分;股胫角FTA分别为(179.3±7.6)°和(180.2±2.6)°。结果显示患者术前、术后的HSS评分、髌骨评分、膝前痛评分、髌骨功能评分差异均有显著意义(P<0.01)。结论:全膝关节表面置换?

AIM:To retrospectively analyze the effect of total knee replacement and reserving patella with denervation on patellar motion trace and anterior knee pain so as to provide references for the clinical treatment.METHODS:From December 1999 to December 2003,304 knees in 182 patients with osteoarthritis(196 knees) or rheumatoid arthritis(108 knees),who were hospitalized in the Department of Orthopaedics,General Hospital of Chinese PLA,were treated with total knee replacement and reserving patella with denervation.There were 41 males and 141 females aged from 45 to 81 years.The way of reserving patella with denervation included:removing peripatellar osteophyte,exposing spongy bone,smoothing the fringe of patella,recovering the original dissected form of patella,cutting off soft tissues and part patellar nerves with electrocoagulation,renovating facet of patella to make it smooth and releasing patellar retinaculum when no thumb test was positive after trail correct dislocation.The patients were scored using the American HSS Score for knees and the Feller Score for patella.The degree of anterior of knee pain was investigated when questionnaire and physical examination were performed.Anterior and lateral views of patella,and patella at 30° and 90° were taken with radiography.RESULTS:The preoperative and postoperative HSS scores of patients were respectively (38.3± 16.7) and (86.3± 11.3) points,scores for patella were(15.6± 5.7)and (25.8± 3.0)points,scores for anterior knee pain were (6.5± 4.6) and (12.3± 2.7) points,scores for patellar function were (5.6± 2.8) and (8.6± 1.4) points,and femoral tibial angles were(179.3± 7.6)° and (180.2± 2.6)° .It was shown that there were significant differences in the HSS scores,scores for patella and anterior knee pain,and scores for patellar function before and after operation in the two groups(P< 0.01).CONCLUSION:Total knee replacement and reserving patella with denervation may effectively improve anterior knee pain and it shows no effect on patellar motion trace.