单髁置换术中髌骨去神经化治疗膝骨性关节炎临床研究

Clinical study of patellar denervation in the treatment of knee osteoarthritis during unilateral condylar replacement

目的探讨膝前内侧骨性关节炎合并髌股关节炎患者行单髁置换术中髌骨去神经化对术后膝前痛发生率及膝关节功能的影响。方法选取收治的膝前内侧骨性关节炎伴有轻度髌股关节炎患者60例,随机分为实验组和对照组,实验组给予单髁置换术中髌骨去神经化处理,对照组仅行单髁置换术,比较两组患者术后膝关节KSS评分、髌骨Feller评分、Kujala评分、膝前痛发生率、髌骨倾斜角的变化。结果60例患者均获得随访,平均随访时间8(6~12)个月,术后1个月、3个月实验组髌骨Feller评分、KSS评分较高,两组比较,差异有统计学意义(P<0.05);术后半年随访时实验组髌骨Kujala评分较高,两组比较,差异有统计学意义(P<0.05);实验组膝前痛发生率较低,两组比较,差异有统计学意义(P<0.05),两组术后髌骨倾斜角及患者主观满意度差异无统计学意义(P>0.05)。结论髌骨去神经化在单髁置换术后早期对降低膝前痛发生率、改善膝关节功能有明显临床效果。

Objective To investigate the effect of patellar denervation on the incidence of anterior knee pain and knee function in patients with anteromedial knee osteoarthritis and patellofemoral degeneration after unicompartmental knee arthroplasty.Methods A retro⁃spective investigation was performed on 60 patients with medial anterior knee osteoarthritis and mild patellofemoral arthritis who were treated in the hospital.The patients were divided into the experimental group and the control group according to the systematic random number meth⁃od.The experimental group was treated with patellar denervation during the unicompartmental knee arthroplasty,and the control group was treated with unicompartmental knee arthroplasty only.The KSS score of knee joint,Feller and Kujala score of patella,incidence of anterior knee pain,patellar inclination angle,patient satisfaction and other complications were analyzed and compared between the two groups.Results All 60 patients were finished the tasks of follow⁃up,the mean time was 8 months(6~12).At the follow⁃up of one month and three months after operation,the patella Feller and KSS scores of the experimental group were higher than those of the control group,with significant differ⁃ences(P<0.05);The Kujala score of the patella in the experimental group was higher than that in the control group during the follow⁃up half a year after the operation,and the difference was statistically significant(P<0.05);The incidence of anterior knee pain in the experimental group was lower than that in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in patellar inclination angle and patient subjective satisfaction between the two groups(P>0.05).Conclusion Denervation of patella has obvious clinical effect on reducing the incidence of anterior knee pain and improving the function of knee joint in the early stage after unicompartmental knee arthroplasty.