全膝关节置换术中髌骨置换与否对膝前痛发生的影响

Effect of patella resurfacing versus nonresurfacing in total knee arthroplasty on anterior knee pain

【目的】回顾性分析、比较全膝关节置换术中髌骨置换与否对膝前痛发生的影响，为临床治疗提供参考。【方法】对1994年10月～2004年10月行人工全膝关节置换术病人125例（148膝）按髌骨置换（84膝）和未置换（64膝）分为2组，并对其随访资料进行分析，膝关节评分采用HSS评分系统，髌骨评分采用Feller评分标准。结果使用SPSS统计软件进行统计学分析。【结果]置换组HSS评分由术前的（39．6±39．8）分进步为末次随访时的（90．9±8．2）分，髌骨评分由（14．4±6．4）分进步到（25．2±4．8）分，膝前痛分数也由（4．6±3．9）分进步为（10．6±4．1）分；未置换组HSS评分由术前的（38．8±9．8）分进步为（90．2±8．9）分，髌骨评分由（14．2±6．2）分进步到（25．1±4．8）分，膝前痛分数也由（4．8±3．8）分进步为（10．3±4．1）分。2组患者末次随访时膝前痛均较术前明显减轻，差异有显著性意义；置换组与未置换组比较，膝前痛减轻的差别无显著性意义。[结论]无论髌骨置换与否，患者的合理选择和正确的手术操作是避免术后膝前痛的关键所在。

[ Objective] To compare retrospectively the clinical outcome in total knee arthroplasty with and without patellar resurfacing. [Method] From October 1994 to October 2004, 125 patients （ 148 knees） with osteoarthritis were enrolled in the clinical trial of total knee arthroplasty, patients received resurfacing （84 knees ） or retention patellar （64 knees ） . Evaluation was done from preoperatively to final followed-up postoperatively. The patients were scored using American HSS Score for knee and the Feller Score for patalla. The data were analyzed using SPSS software. [ Result ] In resurfacing patella group, the preoperative and final follow-up HSS scores of patients were （ 39. 6 ± 9. 8 ） and （90. 9 ± 8.2） points respectively, scores of patailar were （ 14. 4 ± 6. 4） and （ 25.2 ± 4. 8）, scores of anterior knee pain were （4.6 ± 3.9） and （ 10. 6 ± 4. 1 ）. In nonresurfacing patella group, the preoperative and final follow-up HSS scores of patients were （ 38. 8 ± 9. 8） and （90. 2 ± 8.9） points respectively, scores of patallar were （ 14. 2 ± 6. 2 ） and （ 25.1 ± 4. 8 ）, scores of anterior knee pain were （ 4. 8 ± 3. 8 ） and （ 10. 3 ± 4. 1 ）. There were significant differences in beth groups preoperatively and postoperatively in anterior knee pain score, but no significant difference between the two groups in anterior knee pain score. [ Conclusion ] Whether the patellar replaced or not, the most importance for avoiding anterior knee pain postoperatively is the reasonable selection of patient and correct operation.