Genesis Ⅱ与PFC两种假体全膝关节置换术后膝前痛的比较研究

Comparison of anterior knee pain after total knee arthroplasty using Genesis H and PFC knee pros-theses

目的探讨全膝关节置换术后膝前痛与髌骨置换及假体设计的关系，Genesis Ⅱ与PFC两种股骨假体与髌骨之间的友好性。方法回顾性分析由同一组高年资医生施行初次全膝关节置换术的145例（145膝）骨关节炎患者的临床资料。均采用后十字韧带替代型全膝关节假体，髌骨置换74例，其中32例使用Genesis Ⅱ假体、42例使用PFC假体；髌骨未置换71例，其中38例使用GenesisⅡ假体、33例使用PFC假体。术后评估美国特种外科医院（Hospital for Special Surgery，HSS）膝关节评分、髌骨评分、髌骨功能评分、膝关节活动度、膝前痛评分、满意度和X线片上髌骨倾斜和半脱位情况。结果随访144例，随访时间21-43个月，平均33个月。术后膝前痛发生率：髌骨置换组与未置换组的差异无统计学意义，组内使用Genesis Ⅱ假体与PFC假体的差异有统计学意义。使用PFC假体者4例再次手术。功能评分：髌骨置换组及髌骨未置换组中使用Genesis Ⅱ假体与PFC假体术后HSS评分、活动度、满意度的差异均无统计学意义，而术后髌骨评分及髌骨功能评分的差异有统计学意义。结论术后膝前痛的发生率与是否置换髌骨无关，而与假体设计有关；GenesisⅡ假体与髌骨的关系更加友好。

Objective To explore relationship between anterior knee pain after total knee arthroplasty and patella resurfacing and prosthesis design, and to evaluate which femoral prosthesis is more friendly with patella： Genesis Ⅱ or PFC knee prostheses. Methods Data of 145 patients （145 knees） who had undergone primary total knee arthroplasty for treating osteoarthritis were retrospectively analyzed. Posterior-cruciate-substituting total knee prostheses were used in all patients. Among 74 patients who had undergone patella resurfacing, Genesis Ⅱ knee prosthesis was used in 32 patients and PFC knee prosthesis in 42 patients. Among 71 patients who had not undergone patella resurfacing, Genesis 11 knee prosthesis was used in 38 patients and PFC knee prosthesis in 33 patients. The Hospital for Special Surgery（HSS） score, patella score, patellar function score, range of motion of knee, anterior knee pain scale, and patient satisfaction were used to evaluate clinical outcomes. At the same time, the imaging results were evaluated by X-rays. Results 144 patients were successfully followed up for 21 to 43 months （average, 33 months）. There was no signifi- cant difference in incidence of anterior knee pain between the group with patella resurfacing and the group without patella resurfacing, while a significant difference was found between patients receiving Genesis Ⅱ knee prosthesis and those receiving PFC knee prosthesis. Four patients who had undergone total knee arthroplasty using PFC prosthesis underwent reoperation. There were no significant differences in postopera- tive HSS score, range of motion of knee and patient satisfaction between the Genesis Ⅱ group and the PFC group, while there were significant differences in patella score and patellar function score between them. Conclusion Postoperative anterior knee pain was related to the prosthesis design, rather than to the patella resurfacing. Genesis Ⅱ knee prosthesis was more friendly with patella than PFC knee prosthesis.