膝关节置换术中髌骨置换对骨关节炎患者预后及生存率的影响

Effect of patellar replacement on the prognosis and survival rate of patients with osteoarthritis in knee replacement

目的探讨膝关节置换术中髌骨置换对骨关节炎患者预后及生存率的影响。方法回顾性分析2012年1月至2014年4月我院收治的120例膝关节骨关节炎患者(共120膝)的临床资料,其中术中置换髌骨(观察组)或不置换髌骨(对照组)者各60例。术后随访2年,采用KSS膝评分与功能评分、髌骨评分(PS)、疼痛视觉模拟评分(VAS)评价并比较两组患者的膝关节功能,应用生存曲线比较两组患者的生存率。结果两组患者术后6周、3个月、6个月、1年的KSS膝评分、KSS功能评分、PS评分均明显高于术前,而VAS评分低于术前,差异均具有统计学意义(P<0.05);同时,观察组术后6个月、1年的KSS功能评分分别为(80.4±13.8)分、(88.4±6.1)分、PS评分分别为(19.6±4.6)分、(24.9±4.2)分,明显高于对照组的(67.6±11.2)分、(76.3±12.4)分和(17.1±3.3)分、(18.5±2.2)分,而VAS评分[(3.3±1.1)分、(2.4±0.9)分]低于对照组[(4.3±1.3)分、(3.5±1.1)分],差异均具有统计学意义(P<0.05);术后2年两组患者的髌骨倾斜角、髌骨适合角、胫骨角、髌韧带比值及生存率比较差异均无统计学意义(P>0.05)。结论在全膝关节置换术中置换髌骨可明显提高患者膝关节功能,减轻疼痛,而对2年生存率无明显影响。

Objective To investigate the effect of patellar replacement on the prognosis and survival rate of patients with osteoarthritis in knee arthroplasty. Methods The clinical data of 120 cases of knee osteoarthritis patients（120 knees） who admitted to our hospital from January 2012 to April 2014 were retrospectively analyzed, including 60 cases of intraoperative replacement of the patella（the observation group） and 60 cases of no replacement of the patella（the control group）. The patients were followed up for 2 years, and the knee function of the two groups was evaluated by Knee Society knee score（KSS） and functional score, patella score（PS） and pain visual analogue scale（VAS）, and the survival rates of the two groups were compared by using survival curves. Results The KSS knee score, KSS function score and PS score of the two groups after 6 weeks, 3 months, 6 months and 1 year were significantly higher than those before the operation. However, the VAS score was significantly lower than that of the two groups（P〈0.05）. The KSS function score and PS score of the observation group after 6 months and 1 year were（80.4±13.8） and（88.4±6.1）,（19.6±4.6） and（24.9 ± 4.2）, respectively, which were significantly higher than（67.6 ± 11.2） and（76.3 ± 12.4）,（17.1 ± 3.3） and（18.5±2.2） of the control group. However, the VAS scores of the observation group were（3.3±1.1） and（2.4±0.9）, which were significantly lower than（4.3±1.3） and（3.5±1.1） of the control group（P〈0.05）. There was no significant difference after two years between the two groups in the patellar tilt angle, patellar angle, tibial angle, patellar ligament ratio and survival rate（P〉0.05）. Conclusion Replacement of patella in total knee arthroplasty can significantly improve the function of knee joint, reduce pain, which has no significant effect on 2-year survival rate.