髌股关节置换术治疗单纯髌股关节炎的疗效研究

Patellofemoral arthroplasty for the treatment of patellofemoral arthritis

目的:探讨髌股关节置换术治疗单纯髌股关节炎的临床疗效。方法:2013年7月至2017年6月行髌股关节置换术患者35例42膝,女34例,男1例;年龄45~70(55.0±8.2)岁;病程6~36(13.7±2.5)个月。术前及末次随访时对患者进行牛津膝关节评分,末次随访时对患者进行手术满意度评估,另摄膝关节正侧位X线片及髌骨轴位片,评估有无假体松动,记录患者术后出现的血肿、关节感染等并发症。结果:35例患者42膝随访时间18~65(35.0±7.2)个月,手术时间(56.2±8.7)min。牛津膝关节评分由术前(28.14±0.36)分提高至术后末次随访(37.19±0.47)分,差异有统计学意义(P<0.05),其中疼痛项目评分由术前(10.12±0.26)分提高至术后末次随访(15.83±0.30)分,功能项目评分由术前(18.02±0.13)分提高至术后末次随访(21.36±0.23)分,差异均有统计学意义(P<0.05)。有1例患者双膝术后早期出现伤口线结反应,经清创后好转;另1例术后5周出现伤口周围红肿,经抗生素治疗后好转;1例术后1个月出现股四头肌缝合处撕裂,经重新缝合后好转;未发现假体松动者。结论:第2代假体髌股关节置换术治疗单纯严重髌股关节炎早期临床疗效满意,并发症少,但应严格把握手术指征,严重病例可选用膝关节CT扫描定制髌股关节假体,减少术后并发症,提高临床疗效。

Objective:To explore the clinical effect of patellofemoral joint replacement in the treatment of patellofemoral arthritis.Methods:From July 2013 to June 2017,35 patients with 42 knees underwent patellofemoral arthroplasty,including 34 females and 1 male,aged 45 to 70(55.0±8.2)years old,with a course of 6 to 36(13.7±2.5)months.Before and at the end of the follow-up,the patients were assessed with Oxford knee score,satisfaction with the operation was assessed at the end of the follow-up.In addition,X-ray films of the front and side of the knee joint and axial films of the patella were taken to assess whether the prosthesis was loose,and complications such as hematoma and joint infection were recorded.Results:Forty-two knees of 35 patients were followed up for 18 to 65(35.0±7.2)months,and the operation time was(56.2±8.7)min.Oxford knee joint score increased from preoperative 28.14±0.36 to 37.19±0.47 at the end of the follow-up(P<0.05).The score of pain items increased from preoperative 10.12±0.26 to 15.83±0.30 at the end of the follow-up,and the score of functional items increased from preoperative 18.02±0.13 to 21.36±0.23 at the end of the follow-up(P<0.05),there was statistical significance(P<0.05).In one case,there was wound suture reaction in the early postoperative period,which was improved after debridement;in the other case,there was swelling around the wound 5 weeks after operation,which was improved after antibiotic treatment;in one case,there was tear at the suture of quadriceps femoris muscle at 1 month after operation,which was improved after re suture;no loosening of prosthesis was found.Conclusion:The second generation of patellofemoral arthroplasty for the treatment of simple severe patellofemoral arthritis has satisfactory early clinical effect and few complications,but the indication of operation should be strictly grasped.For severe cases,CT scan of knee joint can be used to customize the patellofemoral prosthesis,so as to reduce postoperative complications and improve the clinical effect.