保留髌骨型全膝关节置换术的中期疗效

The Intermediate Outcomes of Total Knee Arthroplasty without Patellar Resurfacing

目的评价膝关节退变性骨关节炎行保留髌骨型全膝关节置换术（total knee arthroplasty,TKA）后膝前痛发生率、临床功能及髌骨软骨退变等级对临床疗效的影响。方法回顾分析2006年2月至2009年2月采用保留髌骨型TKA治疗151例（151膝）膝关节退变性骨关节炎患者的临床资料。其中男59例,女92例;平均年龄72.3岁（56-82岁）。髌骨软骨退变等级采用Outerbridge分级标准、术后膝前痛采用VAS评分、临床功能采用美国膝关节学会评分（the knee society scale,KSS）和髌骨评分（Patellar scores,PS）。结果平均随访时间（6.4±1.8）年。所有患者切口达Ⅰ期愈合。髌骨软骨退变等级：Ⅰ级18例,Ⅱ级36例,Ⅲ级62例,Ⅳ级35例。末次随访时,6例（4.0%）患者有膝前疼痛,其中轻度疼痛4例,中度2例,无重度疼痛。患者平均KSS评分由术前（82.6±9.3）分提高到术后（169.8±13.2）分;患者平均PS由术前（10.5±3.3）分提高到术后（27.8±4.5）分。不同髌骨软骨退变不影响术后膝前痛发生率（χ2=0.42,P=0.94）、KSS评分（膝评分：F=1.83,P=20.14;功能评分：F=0.56,P=20.64）和PS评分（F=0.78,P=20.51）。结论膝关节退变性骨关节炎行保留髌骨型TKA术可取得满意的临床疗效,髌骨软骨退变等级不影响临床疗效。

Objective To evaluate anterior knee pain and clinical function after total knee arthroplasty （TKA） without patellar resurfacing for degenerative osteoarthritis, and analyze whether patellar chondromalacia influence on clinical outcome. Methods 151 patients （ 151 knees） underwent TKA without patellar resurfacing between February 2006 and February 2009 was retrospective studied. There were 59 male and 92 female. The mean age was 72.3 years （range,56 - 82 years）. These data were evaluated, including patellar chondromalacia using Outerbridge classification, anterior knee pain using visual analogue scores （VAS） ,clinical function using the Knee Society clinical scoring system （KSS） and Patellar scores （PS）. Results Mean follow-up time was （6.4 ±1.8） years （ range, 5 - 8 years）. All wound obtained healing by first intention. There were grade I in 18 patients,grade Ⅱ in 36 patients,grade Ⅲin 62 patients,and grade IV in 35 patients. At the final follow-up, there were 6 （4.0%） patients with anterior knee pain （mild pain in 4 patients, moderate pain in 2 patents and none of patients with severe pain）. The mean KSS was preoperative （82.6 ±9.3 ） points （range, 31 - 129 points） improved to postoperative （ 169.8 ± 13.2 ） points （ range, 100 - 191 points） ; the mean PS was preoperative （ 10.5 ±3.3 ） points （ range,6 - 11 points） ; improved to postoperative （27.8 ±4.5） points （ range,26 - 30 points）. The patellar chondromalacia were not influ- ence on anterior knee pain （ x^2 = 0.42,P = 20.94 ） , KSS （ KS ： F = 1.83,P = 20.14 ; FS ： F = 0.56, P = 20.64 ） and PS （ F3 = 0.78 ,P =20.51 ）. Conclusion TKA without patella resurfacing for degenerative osteoarthrosis, can obtain good-to-excellent clinical outcomes, and the patellar chondromalacia may not affect the clinical outcomes.