初次全膝关节置换术中髌骨去神经支配对术后膝前痛的影响

Effect of patellar denervation during initial total knee arthroplasty on postoperative anterior knee pain

目的探讨初次全膝关节置换术(TKA)中采用髌骨去神经支配(PD)对术后膝前痛的影响。方法抽取2017年4月至2019年3月于南阳市骨科医院接受治疗的行初次全膝关节置换术患者252例,依据双盲法分为观察组与对照组,每组126例。观察组在初次全膝关节置换术中采用髌骨去神经支配,对照组在初次全膝关节置换术中未采用髌骨去神经支配。分别于术前及术后3、12、24个月,比较两组患者的膝关节活动范围(ROM)、髌骨评分、视觉模拟评分法(VAS)评分及膝关节疼痛分级。结果术后3、12、24个月,观察组ROM分别为(95.39±3.71)°、(103.79±5.03)°、(103.63±5.34)°,优于对照组的(90.86±4.94)°、(98.59±5.20)°、(100.24±5.62)°,P<0.05。术后3个月,观察组VAS评分、髌骨评分、膝关节前侧疼痛分级均优于对照组,差异有统计学意义(P<0.05)。结论初次全膝关节置换术中的髌骨去神经支配的患者满意度更高,可于术后早期缓解疼痛。

Objective To investigate the effect of patellar denervation(PD)on postoperative knee pain during initial total knee arthroplasty(TKA).Methods A total of 252 patients underwent TKA in Nanyang Orthopedic Hospital from April 2017 to March 2019 were selected and divided into observation group and control group according to the double-blind method,with 126 cases in each group.The observation group used PD in initial TKA,while the control group was treated by initial TKA without PD.The range of motion(ROM),Bartlett score,visual analogue scale(VAS)score and knee pain grade were compared between the two groups before treatment and 3,12,and 24 months after treatment.Results After 3,12,and 24 months of treatment,the ROM of the observation group were(95.39±3.71)°,(103.79±5.03)°,and(103.63±5.34)°,respectively,better than the(90.86±4.94)°,(98.59±5.20)°,and(100.24±5.62)°of the control group(P<0.05).Three months after operation,VAS score,Bartlett score and anterior knee pain grade in the observation group were better than those in the control group(P<0.05).Conclusions Patients treated by PD during initial TKA had higher satisfaction,and the treatment can relieve pain early after operation.