全膝关节置换术中髌骨成形联合软骨面切除成形对早期功能及膝前痛的影响

Influence of patelloplasty combined with cartilage surface resection on early function and anterior knee pain during total knee arthroplasty

目的探讨全膝关节置换术(TKA)中髌骨成形联合软骨面切除成形对早期功能及膝前痛的影响。方法采用前瞻性对照研究方法,选取2021年2月—2022年4月山东省邹城市人民医院收治的100例膝关节骨性关节炎(KOA)行TKA治疗的患者,采用随机数字表法将其分为两组:联合组和对照组,每组各50例。联合组患者TKA术中行髌骨成形联合软骨面切除成形术,对照组患者TKA术中仅行髌骨成形术。记录两组术前骨关节炎Kellgren-Lawrance(K-L)分级、关节活动度(ROM)、手术时间、血红蛋白比术前下降值,术后1、3、6、12个月采用美国特种外科医院膝关节功能评分(HSS)测评膝关节功能,采用视觉模拟评分(VAS)评价患者爬楼梯时的膝前痛症状,采用Feller评分系统评估髌股关节恢复情况。计量资料以均数±标准差(±s)表示,组间比较采用t检验;计数资料组间比较采用χ^(2)检验。结果两组患者术前K-L分级、ROM比较,差异均无统计学意义(P>0.05);联合组患者的手术时间长于对照组[(71.49±9.34)min比(66.27±8.22)min],差异具有统计学意义(P<0.05);两组患者的血红蛋白比术前下降值差异无统计学意义(P>0.05);术后3、6、12个月,联合组患者的HSS评分高于对照组[术后3个月:(76.93±8.26)分比(71.74±7.84)分,术后6个月:(85.72±6.27)分比(81.47±6.19)分,术后12个月:(88.64±5.27)分比(85.72±4.85)分],差异均具有统计学意义(P<0.05);术后1、3、6、12个月,联合组患者膝前痛VAS评分低于对照组[术后1个月:(2.54±0.48)分比(2.77±0.63)分,术后3个月:(2.02±0.53)分比(2.58±0.45)分,术后6个月:(1.32±0.35)分比(1.97±0.38),术后12个月:(1.14±0.33)分比(1.75±0.35)分],差异均具有统计学意义(P<0.05);联合组患者术后3、6、12个月膝前痛发生率低于对照组[术后3个月:20.0%比38.0%,术后6个月:14.0%比32.0%,术后12个月:10.0%比28.0%],差异均具有统计学意义(P<0.05);术后3、6、12个月,联合组患者髌骨Feller评分高于对照组[术后3个月:(18.63±3.52)分比(15.36±3.28)分,术后6个月:(22.27±3.18)分比(19.63±3.48)分,术后12个月:(25.82±3.27)分比(22.47±3.47)分],差异均具有统计学意义(P<0.05)。结论TKA术中行髌骨成形联合软骨面切除成形可有效预防术后膝前痛的发生,改善治疗效果。

Objective To investigate the effects of patelloplasty combined with cartilage surface resection on early function and anterior knee pain during total knee arthroplasty(TKA).Methods This is a prospective controlled study,100 patients with knee osteoarthritis(KOA)who received TKA treatment in Zoucheng People's Hospital of Shandong Province from February 2021 to April 2022 were selected and divided into the combined group and the control group using the random number table method,50 cases in each group.The combined group received patelloplasty combined with cartilage surface resection during TKA,while the control group only received patelloplasty.Preoperative osteoarthritis Kellgren-Lawrance(K-L)grade,joint motion(ROM),the operation time and the decrease of hemoglobin in two groups were recorded.Knee function was evaluated by Hospital for Special Surgery(HSS)knee score at 1,3,6,and 12 months after surgery.Anterior knee pain during stair climbing was evaluated by visual analogue scale(VAS),and recovery of patellofemoral joint was evaluated by Feller score system.The measurement data were represented as mean+standard deviation(x+s),and the comparison between groups was conducted using the t-test;the comparison of count data between groups was conducted by Chi-square test.Results There was no significant difference in preoperative K-L grading and ROM between the two groups(P>0.05).The operation time of the combined group was longer than that of the control group[(71.49±9.34)min us(66.27±8.22)min],the difference was statistically significant(P<0.05),and there was no statistical significance in the decrease of hemoglobin between the two groups(P>0.05).At 3,6 and 12 months after treatment,the HSS scores of the combined group were higher than those of the control group[3 months:(76.93±8.26)us(71.74±7.84),6 months:(85.72±6.27)s(81.47±6.19),12 months:(88.64±5.27)us(85.72±4.85)],the difference were statistically significant(P<0.05).At 1,3,6 and 12 months after treatment,the VAS scores of anterior knee pain in combined group were lower than those in control group[1 months:(2.54±0.48)us(2.77±0.63),3 months:(2.02±0.53)us(2.58±0.45),6 months:(1.32±0.35)us(1.97±0.38),12 months:(1.14±0.33)us(1.75±0.35),the difference were statistically significant(P<0.05).The incidence of anterior knee pain at 3,6 and 12 months after operation in combined group was lower than that in control group[3 months:20.0%vs 38.0%,6 months:14.0%us 32.0%,12 months:10.0%vs 28.0%],the difference were statistically significant(P<0.05).At 3,6 and 12 months after treatment,the patellar Feller score in the combined group was higher than that in the control group[3 months:(18.63±3.52)us(15.36±3.28),6 months:(22.27±3.18)us(19.63±3.48),12 months:(25.82±3.27)vs(22.47±3.47)],the difference were statistically significant(P<0.05).Conclusion Patelloplasty combined with cartilage surface resection during TKA can effectively prevent the occurrence of postoperative anterior knee pain and improve the therapeutic effect.