全膝关节置换术中髌骨置换与髌骨成形对膝关节功能的影响

The influence of knee function to patella replacement and patellar plasty in totle knee arthroplasty

目的探讨髌骨置换与髌骨成形对全膝关节置换术后膝关节功能的影响.方法对2010年8月至11月拟行全膝关节置换术的48例（69膝）膝关节骨关节炎患者进行随机分组，髌骨置换组24例（35膝）、髌骨成形组24例（34膝）。两组患者年龄、体重、身高、体重指数、美国膝关节协会（KneeSocietyScore，KSS）膝评分及功能评分、髌骨评分的差异均无统计学意义。比较两组术后6周、3个月、6个月、12个月、24个月的KSS膝评分及功能评分、髌骨评分、术后膝前痛发生率及影像学表现°结果髌骨置换组20例（30膝）与髌骨成形组20例（29膝）获得随访。术后各时点两组KSS膝评分的差异无统计学意义；6个月以后髌骨置换组KSS功能评分高于髌骨成形组，12个月以后髌骨置换组髌骨评分高于髌骨成形组，差异有统计学意义。术后各时点髌骨置换组膝前痛发生率与髌骨成形组的差异有统计学意义。术后24个月髌骨置换组与髌骨成形组术后胫股角（174．25°±0．97°与173．63°±O．48°）、髌韧带比值（1．01±0．09与1．09±0．07）、髌骨倾斜角（4．58°±O．18°与4-41°±0．19°）、髌骨适合角（2．69°±4．15°与2．56°±3．72°）、髌骨移位距离[（1．53±1．34）mm与（1．68±1．23）ram]的差异均无统计学意义°结论全膝关节置换术中行髌骨置换可以改善膝关节和髌骨功能，降低术后膝前痛的发生率。

Objective To investigate the effects on knee function between patella plasty and patellar replacement in total knee arthroplasty. Methods From August 2010 to November 2010, 48 patients （69 knees） of osteoarthritis performed TKA were covered in this study. All the patients were randomly assigned to the following two groups： one group contained 24 patients （34 knees） performed patella plasty, and the other group contained other 24 patients （35 knees） performed patellar replacement. There was no significant dif- ference between the two groups in age, weight, height, BMI, patellar score and the American Knee Society Score （KSS）. Every patient was followed up for 6 weeks, 3 months, 6 months, one year, and two years. All the results, which were used to compare the difference between the two groups, in KSS knee score, knee function score, patellar score, the incidence of anterior knee pain, and imaging findings. Results In this clinical study, 20 patients （30 knees） in patellar replacement group and 20 patients （29 knees） in patella plasty group were followed up. No significant difference was found in the postoperative KSS knee score between 2 groups at each time point. The KSS knee function score in replacement group was significantly higher than that in arthroplasty group at 6, 12 and 24 months after operation. The incidence of anterior knee pain after the surgery in replacement group was significant different from the plasty group at every time point after opera- tion. There was no significant difference in tibiofemoral angle, patellar ligament ratio, patellar tilt angle, con- gruence angle and lateral patellar displacement between two groups at last follow-up. Conclusion Total knee arthroplasty with patella replacement can improve both knee function and patella function, and reduce the incidence of postoperative anterior knee pain.