初次全膝关节置换术后膝前痛预防的研究进展

Progress on prevention for anterior knee pain after primary total knee arthroplasty

全膝关节置换术(total knee arthroplasty,TKA)是治疗终极膝关节病变的有效方法,能有效缓解疼痛,纠正畸形,改善功能,进而提高患者的生活质量。目前,患者的满意程度越来越被认为是评价TKA的一个重要因素。而膝前痛作为初次TKA后的常见并发症,是指发生于膝前或者髌骨周围的疼痛,这严重影响了患者膝关节功能的改善和其对手术的满意程度。因此,膝前痛的减轻成为TKA的重要目标。目前,认为膝前痛的主要机制是髌股关节的高接触应力造成的软骨下骨内压升高和并发于髌骨运行轨迹异常导致的髌骨周围软组织病变。近年来针对如何预防全膝关节置换术后膝前痛的发生进行了大量研究,但是由于各种各样的原因,至今为止不管是髌骨置换,保留髌骨行髌骨周围去神经化,还是活动平台体都不能取得确切而良好的效果。由此可见,初次TKA后膝前痛的防治仍然是一个棘手的问题。此问题的解决,需要对膝前痛发生原因、膝关节假体及髌股关节生物力学特性做进一步研究,并经过大规模的随机对照试验的论证。

Total knee arthroplasty（TKA）identified as an effective treatment for ultimate knee joint disease can effectively relieve pain, correct deformity, improve knee function and enhance the quality of life of patients. Patient satisfaction has been increasingly considered as an important factor in evaluating the success of primary TKA. Anterior knee pain that usually ap- pears in the region of the anterior knee is a recognized complaint for primary TKA and has a strong impact on the improvement of knee function and patient satisfaction of primary TKA. Accordingly,the relief of anterior knee pain has become one of the primary goals of primary TKA. At present, soft tissue lesions around the patellar caused by patellar maltracking and the eleva- tion of internal pressure in subchondral bone because of the high contact stress of patellofemoral joint are both considered as the mechanism of anterior knee pain. For the past few years, on increasing number of studies have focused on the prevention of anterior knee pain following primary TKA. However, none of the past treatment such as patellar resurfacing,patellar denerva- tion without patellar resurfacing or a mobile-bearing prosthesis has a good and affirmative effect on it. The prevention and treat- ment of anterior knee pain following primary TKA still is a difficult solved problem. To address this problem, we need further researches about the cause of anterior knee pain, knee joint prosthesis and biomechanics of patellofemoral joint, as well as lots of randomized controlled trials.