人工髌股关节置换术治疗髌股关节炎的初步观察

Preliminary Observation of Patellofemoral Arthroplasty in Patellofemoral Osteoarthritis

目的探讨人工髌股关节置换术(PFA)治疗髌股关节炎术后的近期疗效。方法自2005年5月～2008年5月,采用PFA治疗22例髌股关节炎,男4例,女18例;年龄51～59岁,平均55岁。按关节软骨损伤Outerbridge等级分级,Ⅲ级8例,Ⅳ级14例。手术采用膝正中切口,注意股骨假体放置在轻度外旋位,重建髌骨原始厚度,充分松解髌骨外侧支持带。术后早期功能锻炼。随访比较手术前后患者疼痛、功能、活动范围、肌力、屈曲畸形、稳定性情况。结果术后随访14～36个月,平均25个月。患者膝前疼痛明显好转,均能完成日常生活动作,上下楼梯自如。HSS评分优8例,良10例,可3例,差1例;优良率81.8%,患者主观满意率为92%。结论PFA手术治疗髌股关节炎近期疗效满意,但应严格掌握手术适应证。术后采取积极的康复训练会明显提高疗效。

Objective To evaluate the short term results of patellofemoral arthroplasty. Methods Twenty-two patients with patellofemoral osteoarthritis underwent patellofemoral arthroplasty from May 2005 to May 2008, which involved 4 males and 18 females, with an average age of 55 years old （range, 51～59 years old）. According to Outerbridge classification, 8 cases were of Ⅲ degree, and 14 N degree. The anterior midline approach was used with lateral patella retinaculum released sufficiently in the operation. It was attentive to fix the femoral prosthesis with slightly external rotation and it was important to reconstruct the thickness of patella. All cases were followed up to evaluate the symptoms, function, range of motion （ROM）, and muscle power of the knee joints. Results The mean duration of follow-up was 25 months （range, 14 to 36 months）. Assessed with HSS scoring system, 8 cases were rated as excellent, l0 as good, 3 as fair and 1 as poor. The excellent and good rate was 81.8%. The patients＇ satisfactory rate was 92%. Conclusion The patellofemoral arthroplasty shows good results for patellofemoral osteoarthritis in short term. The key points to improve the postoperative results are exact indication and positive rehabilitation training after surgery.