改良型股骨假体对降低初次后稳定型全膝关节置换术后髌骨弹响综合征发生率的病例对照研究

Case control study on modified femoral prosthesis in reducing the incidence of patellar clunk syndrome after the initial posterior stabilized total knee arthroplasty

目的：探讨改良型股骨假体应用于初次后稳定型全膝关节置换术的疗效.方法：2012年4月1日至2013年1月1日,因膝关节骨性关节炎入院,由同一位主任医生完成的初次后稳定型全膝关置换术病例,共156例.61例使用改良型股骨假体,男7例,女54例,平均年龄（68.34±5.41）岁;95例使用普通股骨假体,男14例,女81例,平均年龄（69.92±5.11）岁.观察并记录156例患者的性别、年龄、体重指数、Insall-Salvati指数、假体型号、髌骨弹响综合征发生率、术后下肢力线及术后膝关节活动度.平均随访45.31周（36～56周）,记录每例患者随访时的美国膝关节协会评分（AKS评分）.结果：改良型股骨假体组髌骨弹响综合征发生率为0,低于普通股骨假体组的11.48％,且术后膝关节活动度（110.98±10.32）°,优于普通股骨假体组（107.05±8.61）°.术后随访4次,在术后21～28 d改良型股骨假体组膝关节评分129.79±9.63,优于普通股骨假体组126.85±7.79.结论：采用改良设计的新型股骨假体能降低髌骨弹响综合征发生率,并获得更好的早期膝关节功能恢复.

To explore therapeutic effects of modified femoral prosthesis applied in the initial posterior stabilized total knee arthroplasty. Methods：From April 1,2012 to January 1,2013,156 patients with knee osteoarthritis underwent posterior stabilized total knee arthroplasty by the same director of orthopedic surgeon. Sixty-one patients were treated with modified femoral prosthesis ,including 7 males and 54 females ,with an average age of （68.34±5.41） years old ;and 95 patients were treated with conventional designed femoral prosthesis, including 14 males and 81 females, with an average age of （69.92± 5.11 ） years old. Indexes including age, body mass index, Insall-Salvati index, type of prosthesis,occurrence rate of patella click syndrome ,postoperative line of force of lower extremity and postoperative function of the knee joint were observed and recorded. And American Knee Society （AKS） score was used to evaluate the chnical results. Results：All the patients were followed up, and the duration ranged from 36 to 56 weeks,with a mean of 45.31 weeks. Among patients in the conventional designed femoral prosthesis group, 7 patients had patella click syndrome, but there was no patient having patellar click syndrome in the modified femoral prosthesis group. Postoperative knee activity of patients in the modified femoral prosthesis group was （110.98±10.32）° ,which was better than （107.05±8.61）° in the conventional designed femoral prosthesis group. The AKS score in the modified femoral prosthesis group was 129.79±9.63 during 21 to 28 days after operation ,which was higher than 126.85±7.79 in the conventional designed femoral prosthesis group. Conclusion：New designed femoral components are effective to reduce the occurrence rate of postoperative patellar click syndrome and obtain better early functional recovery from knee surery