髌骨成形术对类风湿关节炎全膝关节置换术后髌骨轨迹和膝前痛的影响

Effect of patella reshaping in total knee arthroplasty of rheumatoid arthritis on patellar motion trace and anterior knee pain

分析全膝关节置换术（total knee arthroplastv,TKA）保留髌骨并行髌骨成形术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。2007年1月~2011年1月,共随访类风湿关节炎保留髌骨全膝关节置换术患者226例383膝,其中男51例,女175例,年龄34~85岁。所有患者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,随访时调查膝前痛,拍摄膝关节正、侧及髌骨90度轴位X射片。髌骨成形术：去除髌骨周围所有骨赘,磨平边缘,修整髌骨至Wiberg分型II型,用电刀切除髌骨周围软组织,试模复位后无拇指试验no thumb test阳性者松解髌骨支持带。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）。类风湿关节炎保留髌骨的全膝关节置换术,术中对髌骨进行髌骨成形术处理,使髌骨形态恢复至Wiberg分型II型,术后髌骨运动轨迹良好,膝前痛的发生率低,术后疗效可靠。

To analyze the effect of patella reshaping in total knee arthroplasty of rheumatoid arthritis on anterior knee pain and patellar motion trace so as to provide references for the clinical treatment.From January 2007 to January 2011,383 knees in 226 patients with rheumatoid arthritis,who were treated with total knee replacement and reserving patella with reshaping.There were 51 males and 175 females aged from 34 to 85 years.The way of reserving patella with reshaping included：removing peripatellar osteophyte,smoothing the fringe of patella,reshaping and recovering the patella to Wibergs type II,cutting of soft tissues 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.It showed 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（P0.01）.Total knee replacement of rheumatoid arthritis and reserving pate11a with resharping may effectively improve anterior knee pain and it shows no effect on pateI1ar motion trace.