全膝关节置换中是否需要髌骨置换

Whether patella replacement should be performed in total knee arthroplasty

背景:全膝关节置换中髌骨置换与否一直存在争议。目的:对临床全膝关节置换中是否进行髌骨置换进行对比观察。方法:随机选取2009年7月至2012年4月在盐城市第一人民医院膝关节骨性关节炎患者56例,共60膝,按全膝关节置换时是否进行髌骨置换分为髌骨置换组和髌骨未置换组。结果与结论:全膝关节置换3个月后,髌骨置换组患者在膝关节功能评定量表评分、髌骨评分、活动度和Q角与髌骨未置换组比明显降低(P<0.05),而膝前痛评分和膝外翻角与髌骨未置换组患者的差异无显著性意义(P>0.05)。提示全膝关节置换中合理进行髌骨处理可有效改善髌股关节运动轨迹,明显降低髌骨并发症。对于髌股关节匹配及力线良好的患者保留髌骨可提高关节的功能恢复,在全膝关节置换中进行髌骨置换较髌骨不置换总体效果好。

BACKGROUND： There is consistency of conclusions on whether the patella replacement should be performed in total knee arthroplasty. OBJECTIVE： To comparatively observe whether the patella replacement should be performed in total knee arthroplasty. METHODS： A total of 56 cases （60 knees） with knee osteoarthritis were selected from Yancheng City No.1 People＇s Hospital from July 2009 to April 2012, and divided into patella replacement group and non-replacement group. RESULTS AND CONCLUSION： At 3 months after total knee arthroplasty, the Hospital for Special Surgery score, patella score, activity and Q angle in patella replacement group were lower than those in the non-replacement group （P 〈 0.05）, while there was no significant difference of postoperative anterior knee pain score and knee valgus angle between two groups （P 〉 0.05）. Intraoperative reasonable patellar treatment can effectively improve the trajectory of the pateilofemoral joint, significantly reduce the patellar complications. For the patients with patellofemoral match and a good line of force, to retain the patella in total knee arthroplasty can improve joint function recovery, and the overall effect of patella replacement is better than that of non-replacement.