全膝关节置换术中髌骨处理方法的研究

Management methods of patella in total knee arthroplasty

目的比较全膝关节置换术（totalkneearthroplasty，TKA）中保留髌骨下进行髌骨成形与髌骨置换的术后临床疗效，探讨膝关节置换中合适的髌骨处理方法。方法回顾性分析2002年1月-2008年12月收治的共198例行TKA治疗的单纯骨关节炎患者，其中62例行髌骨置换术，136例行保留髌骨下髌骨成形术。术中对髌骨进行去除骨赘后进行成形，使之与原髌骨关节面比较相近。术后定期随访进行美国膝关节协会评分（KSS）、Bristol髌骨评分、患者满意度、膝关节活动度及分析术后膝前疼痛发生率，并复查X线片了解内置物情况。结果共125例获得随访，其中置换组43例，成形组82例，随访时间36～80个月，平均51个月。两组患者术后较术前各项评分明显提高。术后1年随访时两组患者术后膝关节活动度、KSS总评分、髌骨评分、患者满意度差异无统计学意义，而KSS功能评分两组之间差异有统计学意义，成形组优于置换组。而术后膝前疼痛发生率两者有差异但无统计学意义。术后x线片示髌股匹配程度、术后膝前疼痛发生率及髌骨相关并发症发生率两组间差异无统计学意义。结论髌骨成形术在TKA中髌骨不置换时能够使髌股关节达到良好匹配，术后膝前疼痛发生率低，中短期疗效与髌骨置换相当。

Objective To compare the clinical effects of patellar resurfacing with patella reserva- tion and patellaplasty in the total knee arthroplasty （TKA） for osteoarthritis so as to discuss appropriate management of patellas in TKA. Methods A retrospective study was eonducted on 198 patients with osteoarthritis treated by TKA from January 2002 to December 2008. There were 62 patients managed by patellaplasty （patellaplasty group） and 136 patients by patellar resurfacing with patella reservation （patel- lar resurfaeing group）. The osteophytes of the patella were removed to make the articular surface of patel- las similar to the primary one. Knee Society Score （KSS） , Bristol patellar score, satisfaction survey and evaluation of joint range of motion （ROM） were performed during the regular follow-up. Incidence of postoperative anterior knee pain were analyzed and X-ray films were reviewed to understand the condition of the implants. Results A total of 125 patients were followed up, including 43 patients from the patel- laplasty group and 82 from the patellar resurfaeing group. The mean follow-up period was 51 months （range, 36-80 months）. Both groups showed significant improvement of each score postoperatively. No significant differences were found between the two groups regarding KSS score, patellar score and patient satisfaction in the follow-up one year later; but KSS function score in the patellar resurfaeing group was superior to that in the patellaplasty group, with statistical difference. The incidence of anterior knee pain of the two groups had no statistical significance. Postoperative radiographs revealed no significant differ- ences between the two groups concerning patellofemoral congruence, incidence of postoperative anterior knee pain or incidence of patellar related complications. Conclusion Patellar resurfacing with patella reservation for osteoarthritis in TKA can achieve satisfactory patellofemoral congruence and low incidence of intraoperative anterior knee pain, with comparable mid-term results with patellaplasty.