髌股关节置换术治疗膝关节髌股骨关节炎的中短期疗效观察

Treatment of patellofemoral osteoarthritis with patello-femoral joint arthroplasty

目的 探讨分析髌股关节置换术治疗膝关节髌股骨关节炎的中短期疗效、手术技术及围手术期处理.方法 回顾性分析2010年1月至2012年6月收治的17例24膝髌股关节置换患者资料.其中男性2例4膝,女性15例20膝;年龄52 ～ 77岁,平均（64±9）岁;体重指数（BMI）18.0 ～30.1 kg/m2,平均（24±3）kg/m2.术后3、6个月、1年进行随访,此后每年随访1次.对患者满意度、膝关节疼痛视觉模拟量表（VAS）评分、关节活动度、膝关节美国纽约特种外科医院评分（HSS评分）、Feller髌骨评分、股四头肌肌力等进行评估分析,分析髌股关节置换临床效果、遇到的问题及应对方法.术前、术后的均值比较采用配对样本t检验,随访不同时间点的均值比较采用单组重复测量数据的方差分析.结果 术后随访18 ～47个月,平均（29±10）个月,无返修,无感染、深静脉血栓、假体脱位等.患者1年内满意度75.0％,末次随访满意度87.5％.HSS评分由术前（61±11）分增至（90±6）分（t=12.24,P=0.000）.VAS评分由术前的（6.7±1.0）分降至（2.4±1.0）分（t=15.84,P=0.000）.末次随访的膝关节活动度平均达126°±7°（t=3.25,P=0.003）.Feller髌骨评分术前（18.0±3.2）分,术后3、6个月、1、2年、末次随访分别为（18.5±4.5）、（19.7±3.4）、（24.0±3.8）、（26.0±3.3）、（26.6±2.5）分;股四头肌肌力术前为（3.9±0.5）级,术后3、6个月、1、2年、末次随访分别为（3.7±0.5）、（3.9±0.5）、（4.2±0.5）、（4.3±0.5）、（4.3±0.5）级.单组重复测量数据的方差分析结果显示Feller髌骨评分（F =38.97,P=0.000）及股四头肌肌力（F=6.89,P=0.000）变化差异有统计学意义,但二者术后3、6个月分数较低,与术前相比差异无统计学意义（P＞0.05）;二者在术后1、2年及末次随访的结果与术前、术后6个月相比有明显提高,差异有统计学意义（t=5.65 ～10.65和t=2.18 ～2.73,均P＜0.05）.术后3膝疼痛不缓解,股四头肌肌力均不超4级.结论 髌股关节置换术治疗膝关节髌股间室骨关节炎中短期疗效满意,但是需要加强围手术期股四头肌肌力康复锻炼.

Objective To study the outcome and surgical technique of patello-femoral joint arthroplasty （PFJ） for osteoarthritis of the knee. Methods From January 2010 to June 2012,17 patients （24 knees） with patello-femoral compartmental osteoarthritis treated by PFJ were reviewed retrospectively. There were 2 male patients （4 knees） and 15 female patients （15 knees）, with an average age of （64 ± 9） years （52 - 77 years） . The mean body mass index was （24 ± 3） kg/m2 （ 18.0 - 30. 1 kg/m2 ）. Patients were asked to return for follow-up examinations at 3,6 months and at every year after PFJ. The range of motion （ ROM ）, visual analogue scale （ VAS）, Hospital for Special Surgery score （ HSS score）, Feller patella score, quadriceps muscle strength were evaluated before and after PFJ. The paired sample t-test and one-way analysis of variance （ANOVA） with replicate measures were used to determine whether there were statistically significant differences between the mean data. Results All of the patients were followed up for 18 -47 months, with a mean time of （29 ± 10） months, 75.0% patients were satisfied with the outcome of this surgical procedure 1 year postoperative, and 87.5% were satisfied 2 years postoperative. HSS score wasincreased from 61 ±11 to 90 ±6 at the final follow-up（t = 12. 24, P =0. 000）. VAS score was reduced from 6. 7 ± 1.0 to 2. 4 ± 1. 0（t = 15.84, P =0. 000）. The mean post-operative ROM of the knees was 126° ±7° （t = 3.25, P = 0. 003）. Feller patella scores were 18.0 ± 3.2 before operation, and 18.5±4. 5,19. 7 ± 3.4,24.0 ±3.8,26. 0 ±3.3,26. 6 ±2.5 at 3,6,12,24 months after operation,final follow-up,respectively. Quadriceps muscle strength were 3.9 ±0. 5 before operation, and 3.7 ±0. 5,3.9 ± 0. 5,4. 2 ± 0. 5,4. 3 ± 0. 5,4. 3 ±0. 5 at 3,6, 12,24 months after operation, final follow-up, respectively. Repeated measures ANOVA found significant time effects for Feller patella scores（ F = 38. 97 ,P = 0. 000） and quadriceps muscle （ F = 6. 89, P = 0. 000）. Feller patella scores and quadriceps muscle strength were low at 3, 6 months after operation,with no significant differences compared with preoperation data（ P 〉 0. 05 ）. The improvements of Feller patella scores and quadriceps muscle strength after 6 months were of significant difference compared with preoperation and postoperative 6 months data（ t = 5.65 - 10. 65 and t = 2. 18 -2.73 ,P 〈 0. 05）. Three knee reported continuing pains with quadriceps muscle strength less than 4 level. Conclusions PFJ is an effective method for patello-femoral compartmental osteoarthritis with less trauma. The early term outcome of PFJ is encouraging. Quadriceps muscle strength should be enhanced.