人工全膝置换伸膝装置调整优化髌骨轨迹处理经验

Adjustment and optimization of patellar tracking in extensor mechanism after total knee arthroplasty

目的探讨全膝关节置换伸膝装置的处理效果及评价术中髌骨轨迹的方法。方法选取辽宁本溪第一人民医院2008年3月-2012年2月行全膝关节置换术患者169例（199膝）。男75例（80膝）,女94例（119膝）;类风湿关节炎导致强直膝6例（8膝）,强直性脊柱1例1膝,骨性关节炎162例190膝;髌骨置换组40例（46膝）,未置换组129例（153膝）。平均年龄55.2（36~83）岁。两组术中均重新调整了伸膝装置。术中按Burnet等提出的髌骨置换适应证与禁忌证标准确定是否行髌骨置换,应用＂无拇指试验＂和巾钳试验确定髌骨轨迹是否满意。结果平均随访时间31（18~48）个月。髌股关节并发症髌骨置换组出现2例2膝（4.35%）、未置换组出现4例5膝（3.27%）,两组髌股关节并发症发生率无统计学差异（P〉0.05）。术后3年膝关节协会评分（Knee Society Score,KSS）置换组和未置换组无统计学差异（P〉0.05）。结论全膝关节置换中调整伸膝装置可优化髌骨轨道。联合应用＂无拇指试验＂和巾钳牵拉试验能准确评价髌骨轨迹,是否置换髌骨不会影响术后3年的临床效果。

Objective To study the outcome in extensor mechanism after total knee arthroplasty（TKA） and assess its patellar tracking method.Methods One hundred and sixty-nine patients（199 knees） including 75 males（80 knees） and 94 females（119 knees） who underwent TKA in our hospital from March 2008 to February 2012 were enrolled in this study.Of these patients,6（8 knees） were diagnosed with ankylosis knee due to rheumatoid arthritis,one（1 knee） was diagnosed with ankylosing spondylitis,and 162（190 knees） were diagnosed with osteoarthritis.The patients were divided into patella replacement group（n= 40 with 46 knees） and non-patella replacement group（n=129 with 153 knees）.Their average age was 55.2 years（36-83 years）.The extensor mechanism was readjusted in both groups.The patella replacement was decided according to its indications and contraindications proposed by Burnet et al.Whether the outcome of patellar tracking was satisfactory was judged by ＂no thumb test＂ and ＂towel clamp test＂.Results The patients were followed up for 31 months（18-48 months）.No significant difference was found in complications between patellar replacement group and nonpatellar replacement group（P 0.05）,which occurred in 2 patients（2 knees） of patellar replacement group（accounting for 4.35%） and in 4 patients（5 knees） of non-patellar replacement group（accounting for 3.27%）.No significant difference was observed in the KSS（Knee Society Score） score between the two groups 3 years after operation（P 0.05）.Conclusion Adjustment of the extensor mechanism can optimize the patella tracking after TKA.Combined＂no thumb test＂and＂towel clamp test＂can accurately assess the patellar tracking.Patella replacement does not affect the clinical outcome 3 years after operation.