人工全膝关节置换术中髌骨置换的临床研究

CLINICAL STUDY ON PATELLAR REPLACEMENT IN TOTAL KNEE ARTHROPLASTY

目的通过与非髌骨置换比较,探讨髌骨置换对人工全膝关节置换术疗效的影响。方法将2010年9月-11月符合选择标准的63例(63膝)拟行人工全膝关节置换术的骨关节炎患者随机分为两组,其中32例关节置换术中行髌骨置换(置换组),31例不作置换(非置换组)。两组患者性别、年龄、病程、骨关节炎分级、美国膝关节协会评分系统(KSS)标准临床评分及关节功能评分、髌骨评分、髌骨倾斜角、胫股角及髌韧带比值等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。术后6周及3、6、12个月对疗效进行临床及影像学评定。结果两组患者术后切口均Ⅰ期愈合,置换组6例、非置换组8例出现下肢深静脉血栓形成。患者均获12个月随访。置换组术后3、6、12个月时膝前疼痛发生率均低于非置换组(P<0.05)。两组术后各时间点KSS临床评分比较,差异无统计学意义(P>0.05);除术后6周及3个月,其余各时间点置换组关节功能评分明显高于非置换组(P<0.05)。两组髌骨评分除术后12个月外,其余各时间点组间比较差异均无统计学意义(P>0.05)。X线片复查示,两组均无髌骨骨折、髌骨脱位、髌骨不稳、假体松动及断裂发生;术后12个月两组股胫角、髌韧带比值、髌骨倾斜角比较,差异均无统计学意义(P>0.05)。结论人工全膝关节置换术中行髌骨置换可以一定程度改善膝关节功能评分、髌骨评分及降低术后膝前疼痛的发生率。

Objective To evaluate the influence of patellar replacement on total knee arthroplasty by comparing with non pattelar replacement. Methods Between September 2010 and November 2010, 63 patients （63 knees） with osteoarthritis who met the selection criteria and underwent total knee arthroplasty, were randomly divided into 2 groups： patellar replacement in 32 cases （replacement group）, non patellar replacement in 31 cases （non pattelar replacement group）. There was no significant difference in gender, age, disease duration, osteoarthritis grading, the clinical and functional scores of American Knee Society Score （KSS）, the patellar tilt angle, tibiofemoral angle, and patellar ligament ratio between 2 groups （P 〉 0.05）, they were comparable. After 6 weeks, 3, 6, and 12 months of operation, clinical and imaging evaluation methods were used to assessment the effectiveness. Results Primary healing of incision was obtained in all patients of 2 groups. Deep venous thrombosis occurred in 6 cases of replacement group and in 8 cases of non pattelar replacement group. All patients were followed up 12 months. The postoperative incidence of anterior knee pain in replacement group was significantly lower than that in non pattelar replacement group （P 〈 0.05） at 3, 6, and 12 months after operation. No significant difference was found in the postoperative KSS clinical score between 2 groups at each time point （P 〉 0.05）. The joint function score of the replacement group was significantly higher than that of the non pattelar replacement group at the other time point （P 〈 0.05） except the score at 6 weeks and 3 months. Significant difference was found in the patella score between 2 groups at 12 months （P 〈 0.05）, but no significant difference at the other time points （P 〉 0.05）. X-ray film showed no patellar fracture and dislocation, or loosening and breakage of internal fixation. At 12 months after operation, the tibiofemoral angle, the patellar ligament ratio, and the patellar tilt angle showed no significant difference between 2 groups （P 〉 0.05）. Conclusion Patella replacement can improve knee function score and the patella score, and reduce the incidence of postoperative anterior knee pain.