未行髌骨置换的全膝关节置换术后髌骨倾斜角对疗效的影响

Effect of patellar tilt angle after total knee arthroplasty without patellar resurfacing

目的分析未行髌骨置换的全膝关节置换(total knee arthroplasty,TKA)术后髌骨倾斜角对疗效的影响。方法回顾性分析2020年10月至2021年10月于南京医科大学第一附属医院骨科接受TKA而未行髌骨置换的143例终末期膝关节骨关节炎患者,男32例、女111例,年龄(68.44±6.79)岁(范围52~86岁)。根据术后髌骨倾斜角的大小分为三组:倾斜角<5°为轻度倾斜组(97例)、5°≤倾斜角<10°为中度倾斜组(31例)、倾斜角≥10°为重度倾斜组(15例)。术后3、6、12个月在门诊进行随访,观察并记录患者的膝关节疼痛视觉模拟评分(visual analogue score,VAS)、美国特种外科医院(Hospital for Special Surgery,HSS)评分及髌骨Feller评分,比较不同髌骨倾斜程度组患者术后膝关节疼痛及功能。结果所有患者均获得随访,随访时间为(1.16±0.23)年(范围1.0~2.0年)。患者基线资料的组间差异无统计学意义。三组患者手术前后膝关节VAS评分组内比较的差异均有统计学意义(F=51.12,P<0.001;F=36.90,P<0.001;F=15.76,P<0.001),术后3、6、12个月的膝关节VAS评分均小于术前,差异有统计学意义(P<0.05)。重度倾斜组术后3、6、12个月的膝关节VAS评分均大于轻度组和中度组,差异有统计学意义(P<0.05)。三组患者手术前后膝关节HSS评分组内比较的差异均有统计学意义(F=81.12,P<0.001;F=36.05,P<0.001;F=32.93,P<0.001),术后3、6、12个月的膝关节HSS评分均大于术前,差异有统计学意义(P<0.05);重度倾斜组术后3、6、12个月的膝关节HSS评分均小于轻度组和中度组,差异有统计学意义(P<0.05)。三组患者手术前后髌骨Feller评分组内比较的差异均有统计学意义(F=88.81,P<0.001;F=49.59,P<0.001;F=37.40,P<0.001),术后3、6、12个月的髌骨Feller评分均大于术前,差异有统计学意义(P<0.05);重度倾斜组术后3、6、12个月的髌骨Feller评分小于轻度组和中度组,差异有统计学意义(P<0.05)。结论未行髌骨置换的TKA术后遗留髌骨倾斜角会增加膝关节疼痛,限制关节功能。

Objective To analyze the effect of patellar tilt angle on postoperative outcomes after total knee arthroplasty(TKA)without patella resurfacing.Methods A total of 143 patients with end-stage knee osteoarthritis who underwent TKA without patellar replacement in the First Affiliated Hospital of Nanjing Medical University from October 2020 to October 2021 were retrospectively analyzed.There were 32 males and 111 females,aged 68.44±6.79 years(range,52-86 years).Patients were divided into three groups according to the postoperative patellar tilt angle:tilt angle<5°was the mild tilt group(97 cases),5°≤tilt angle<10°was the moderate tilt group(31 cases),and tilt angle≥10°was the severe tilt group(15 cases).All patients were followed up in the outpatient clinic at 3,6 and 12 months after surgery,and knee visual analogue score(VAS),Hospital for Special Surgery(HSS)score and patella Feller score were observed and recorded to compare the postoperative knee pain and function of patients in different patella tilt groups.Results All patients were followed up for 1.16±0.23 years(range,1.0-2.0 years).There was no significant difference in baseline data between the groups.There were significant differences in the intra-group comparison of the VAS score before and after surgery among the three groups(F=51.12,P<0.001;F=36.90,P<0.001;F=15.76,P<0.001).The VAS scores at 3,6 and 12 months after operation were significantly lower than those before operation(P<0.05).The knee VAS of the severe group was higher than that of the mild and moderate groups at 3,6 and 12 months after surgery,and the difference was statistically significant(P<0.05).There were statistically significant differences in knee HSS scores before and after surgery among the three groups(F=81.12,P<0.001;F=36.05,P<0.001;F=32.93,P<0.001).The knee HSS scores at 3,6 and 12 months after surgery were higher than those before surgery,and the difference was statistically significant(P<0.05).The knee HSS scores of the severe tilt group at 3,6 and 12 months after surgery were lower than those of the mild and moderate groups,and the difference was statistically significant(P<0.05).There were statistically significant differences in the intra-group comparison of the patella Feller score before and after surgery among the three groups(F=88.81,P<0.001;F=49.59,P<0.001;F=37.40,P<0.001).The patellar Feller score at 3,6 and 12 months after surgery was higher than that before surgery,and the difference was statistically significant(P<0.05).The patellar Feller score of the severe group at 3,6 and 12 months after surgery was lower than that of the mild and moderate groups,and the difference was statistically significant(P<0.05).Conclusion Patellar tilt angle after TKA without patellar resurfacing will increase knee pain and limit joint function.