保留髌骨膝关节置换的症状及影像学评价

Radiological and functional evaluation during total knee replacement without patellar resurfacing

背景:膝关节置换中是否置换髌骨是一个持续争论的话题。目的:侧重评价保留髌骨膝关节置换后髌骨的影像学稳定性和症状改善。方法:对39例(48膝)骨关节炎及类风湿性关节炎患者行保留髌骨的全膝关节置换。结果与结论:术中记录髌骨软骨退变分级Ⅲ级和IV级达36膝,占75%,置换后HSS评分及FELLER髌骨评分较置换前明显改善,明显膝前痛病例为5例,占10%,其髌骨病理分级均达到Ⅳ级。保留髌骨膝关节置换前后影像学评价髌股关节的对线差异无显著性意义,下肢力线校正满意。提示对于置换前髌股轨迹不良、术中软骨病理分级较低者应该进行选择性的髌骨置换,恰当选择病例采用保留髌骨的膝关节置换可减少髌股关节并发症,置换前仔细评估,综合考虑多种因素操作可进一步改善髌股轨迹。

BACKGROUND：Controversy remains as to whether or not to resurface the patella in total knee replacement.OBJECTIVE：To investigate the clinical and radiological results of the patella in patients with total knee replacement without patellar resurfacing.METHODS：Thirty-nine patients（48 knees） with osteoarthritis and rheumatoid arthritis underwent total knee replacement without patellar resurfacing.RESULTS AND CONCLUSION：Thirty-six knees（75%） were evaluated as grades Ⅲ and Ⅳ of cartilage Outerbridge classification.HSS score and Feller patella score improved postoperatively.Five of the 48 knee（10%） complained of anterior knee pain,and the patella pathological level reached grade Ⅳ.Selective total knee replacement without patellar resurfacing can lead to reduction of patellofemoral complications and acquire good patellofemoral tracking.