全膝关节置换术中髌骨置换与否对早期疗效及膝前痛的影响

The early clinic analysis of patellar resurfacing or nonresurfacing in total knee arthroplasty

目的探讨全膝关节置换术中髌骨置换与否对早期疗效及膝前痛发生率的影响。方法2010年6月至2011年6月拟行全膝关节置换术患者100例，随机分为两组：髌骨置换组43例50膝，髌骨未置换组57例66膝。比较术后6个月、12个月两组患者的西安大略和麦克马斯特大学（WestOntarioandMcMasterUniversities，WOMAC）骨关节炎指数、美国膝关节外科协会（KneeSurgerySociety，KSS）膝评分和功能评分、膝前痛视觉模拟评分（visualanaloguescale，VAS）。结果髌骨置换组与髌骨未置换组患者术后膝前痛VAS评分均较术前明显降低，两组间VAS评分及膝前痛发生率的差异无统计学意义。WOMAC骨关节炎指数6个月分别为28．8±1．2和18．6±7．2、术后12个月分别为20．7±6．2和16．0±5．5，KSS膝评分6个月分别为（87．0±8．3）分和（90．9±7．2）分、术后12个月分别为（84．2±10．6）分和（88．8±9．2）分，KSS功能评分术后6个月分别为（86．6±21．6）分和（84．9±16．5）分、术后12个月分别为（85．2±16．4）分和（91．0±10．0）分，组间差异均无统计学意义。髌骨轴位x线片示髌骨与股骨假体滑车吻合度良好，无不稳及脱位表现。术后1年内无翻修、髌骨表面再置换病例。结论全膝关节置换术对改善因骨关节炎或类风湿关节炎导致的膝关节疼痛、功能受限有效；髌骨置换与否对术后短期疗效及膝前痛发生率没有影响。

Objective To evaluate the early clinic effects and anterior knee pain after total knee arthroplasty with or without patellar resurfacing. Methods From June 2010 to June 2011, 100 patients who underwent TKA in our department were covered in this study, they were randomly divided two groups： resur- facing of the patellar （42 patients, 50 knee） and nonresuffacing of the patellar （57 patients, 66 knee）. They were followed up at 6th month and 12th month. Comparison was performed with the West Ontario and Mc- Master Universities score （WOMAC） and Knee Surgery Society （KSS） score system, anterior knee pain visual analogue scale （VAS） score between two groups. Results Anterior knee pain VAS score had significant im- provement postoperation in resurfacing groups and nonresurfacing group. But there was no statistical differ- ence between two groups. In two groups, WOMAC scores at 6th month were 28.8±11.2 and 18.6±7.2, 20.7± 6.2 and 16.0±5.5 at 12th month. KSS scores at 6th month were 87.0±8.3 and 90.9±7.2, 84.2±10.6 and 88.8± 9.2 at 12th month. And the KSS function scores at 6th month were 86.6±21.6 and 84.9±16.5, 85.2±16.4 and 91.0±10.0 at 12th month and had no statistical difference between two groups. In sunrise views （Bending 30 degrees）, the curvature tolerance between patella and femoral trochlea was well at two timestamp postopera- tion without instability and dislocation. No revision of TKA and no re-resurfacing of patella one year after TKA. Conclusion TKA is very effective for relief of knee pain and improvement of joint function for OA and RA. Patella resurfacing and nonresurfacing have not significant difference during one year and two ways, and have the same good result in function and anterior knee pain improvement.