髌骨缩小联合外侧支持带松解对膝关节置换术的疗效影响

Analysis of effect of patellar reduction combined with lateral patellar retinaculum release after total knee arthroplasty

目的探讨髌骨缩小联合外侧支持带松解对人工全膝关节置换术后膝前痛发生及膝关节功能疗效的影响。方法筛选2016年1月至2017年6月广东省第二中医院骨科136例退行性膝骨关节炎拟行初次单侧全膝关节置换术的患者136例(136膝),剔除同侧髋病及严重内外翻畸形膝,术前按随机分配法分为观察组(术中行髌骨缩小联合外侧支持带松解,68例)和对照组(术中常规去除髌骨边缘硬化骨但不松解外侧支持带,68例),余手术操作均一致。记录两组患者术前术后膝前痛及并发症发生情况、手术时间、美国特种外科医院(HSS)膝关节评分、髌骨Feller评分、膝前痛评分,并进行术前术后和两组间的比较。拍摄术后膝关节正侧位和Merchant位X(屈膝30°髌骨轴位片)线片,观察髌骨轨迹情况。对计数资料和正态分布的计量资料采用卡方检验或t检验。结果观察组3例患者失访,2例外伤致胫腓骨骨折;对照组7例患者术中行"无拇指"试验发现需松解外侧支持带,排除研究;两组最终纳入63例和61例。所有患者均获得相同的随访时间。观察组术后膝前疼痛率为4.8%(3/63),对照组为16.4%(10/61),观察组优于对照组,差异有统计学意义(t=6.325,P<0.05);两组患者手术时间比较差异均无统计学意义(P>0.05);术后18个月时两组患者HSS评分、Feller评分、膝前痛评分、膝关节活动度均较术前显著改善(P<0.05);但观察组在HSS评分、髌骨Feller评分、膝前痛评分方面明显优于对照组(t=3.125,P<0.05);两组均未发生髌骨坏死、髌骨骨折、髌骨高压等并发症,比较差异无统计学意义(P>0.05)。观察组和对照组分别有2例和11例发生髌骨轨迹不良,比较差异有统计学意义(t=11.218,P<0.05)。结论膝关节置换术中进行髌骨缩小联合外侧支持带松解能明显减少膝前痛及并发症发生,有效改善膝关节功能并较好维持术后髌骨的轨迹,提高TKA手术的整体疗效。

Objective To investigate the effect of patellar reduction combined with lateral patellar retinaculum release on the occurrence of anterior knee pain and the knee joint function after total knee arthroplasty(TKA).Methods A total of 136 cases(136 cases)were collected from the Department of Orthopaedics,Second Hospital of Traditional Chinese Medicine,Guangdong Province between January 2016 and June 2017,excluding ipsilateral hip disease and severe internal and external valgus deformity knees.Before the operation,the patients were divided into two groups according to random distribution(patellar reduction combined with lateral patellar retinaculum release during operation,68 cases),and the control group(removal of patella edge hardening bone but no lateral patellar retinaculum release,68 cases);all the operative procedures were consistent.Preoperative and postoperative knee pain and complications,operation time,American Hospital of Special Surgery(HSS)score,patella Feller score,and anterior knee pain score were recorded before and after the surgery.X-ray film of knee joint and Merchant position(30°patella axis)were taken after operation to observe the patellar tracking.Chi-square test and t test were used to analyze the data.Results Three patients in the observation group were lost to follow up,and two patients were injured in the tibia.In the control group,seven patients underwent a"no thumb"test and found that the lateral patellar retinaculum needed to be released,they were not not involved in this research.The two groups eventually included 63 patients and 61 patients.All the patients got the follow-up at the same time.The preoperative knee pain rate was 4.8%(3/63)in the observation group and 16.4%(10/61)in the control group.The observation group was superior to the control group,and the different was significant(t=6.325,P<0.05).There was no obvious difference between the two groups in the operation time(P>0.05).At 18 months after operation,the HSS score,Feller score,anterior pain of knee score and knee joint activity were improved significantly in both groups(P<0.05).However,the HSS score,patella Feller score and anterior knee pain score were observed in the observation group,and the different was significant(t=3.125,P<0.05).There was no complication such as patellar necrosis,patellar fracture and patellar hypertension in the two groups,and there was no obvious difference between the two groups(P>0.05).There were two patients in the observation group and 11 patients in the control group with bad patellar tracking,and the difference was significant(t=11.218,P<0.05).Conclusion In the knee arthroplasty,patellar reduction combined with lateral patellar retinaculum release can reduce the incidence of anterior knee pain and complications significantly,improve knee function and maintain patellar tracking well,and improve the curative overall effect of TKA.