全膝关节置换术后膝关节线改变与膝前痛的相关性分析

Correlation analysis of changes of knee joint line on anterior knee pain after total knee arthroplasty

目的分析全膝关节置换(TKA)术后膝关节线改变与膝前痛的相关性。方法选取70例(共80膝)膝关节骨性关节炎伴有内翻畸形患者为研究对象,选用同一款假体,均行TKA治疗。手术前后分别测量膝关节线,计算膝关节线的变化程度。术前、术后1年分别进行膝评分、膝关节功能评分及髌骨Feller评分,分析TKA后膝关节线改变对膝前痛的影响。结果术后1年,患者膝评分、膝关节功能评分、髌骨Feller评分分别为(90.7±3.3)、(77.8±3.9)、(26.9±3.5)分,高于术前的(57.7±4.6)、(47.2±4.0)、(10.9±2.3)分,差异有统计学意义(P<0.05)。TKA术后膝关节线水平改变-5.0~10.0(2.09±4.0)mm,膝关节线升高58膝,下降22膝,其中膝关节线改变水平>4 mm者有21膝,膝前痛有8膝;膝关节线改变水平≤4 mm者有8膝,膝前痛2膝。术前,膝关节线改变水平>4 mm的膝评分、膝关节功能评分、髌骨Feller评分分别为(57.3±4.8)、(47.9±3.6)、(10.5±2.5)分,膝关节线改变水平≤4 mm的膝评分、膝关节功能评分、髌骨Feller评分分别为(57.5±5.0)、(45.6±4.0)、(10.5±1.9)分;术后1年,膝关节线改变水平>4 mm的膝评分、膝关节功能评分、髌骨Feller评分分别为(90.5±3.3)、(77.5±3.9)、(24.7±4.8)分,膝关节线改变水平≤4 mm的膝评分、膝关节功能评分、髌骨Feller评分分别为(90.0±3.9)、(77.3±4.1)、(24.6±3.0)分。膝关节线改变水平≤4 mm和>4 mm患者术前、术后1年膝评分、膝关节功能评分、髌骨Feller评分比较,差异有统计学意义(P<0.05)。Pearson相关性分析显示,膝关节线改变水平>4 mm,髌骨Feller评分与膝关节线改变水平呈负相关(r=-0.744,P=0.000<0.05)。膝关节线改变水平≤4 mm,髌骨Feller评分与膝关节线改变水平没有相关性(r=-0.442,P=0.273>0.05)。结论TKA术后膝关节线升高比降低更为常见。膝前痛与TKA后膝关节线的改变密切相关,膝关节线抬高>4 mm是导致膝前痛的重要原因。

Objective To analyze the correlation of changes of knee joint line on anterior knee pain after total knee arthroplasty(TKA).Methods 70 patients(80 knees in total)with knee osteoarthritis with varus deformity were selected,and the same prosthesis was selected for TKA.The joint lines were measured before and after operation,and the change degree of the joint lines was calculated.Knee score,knee joint function score and Feller patella score were performed before operation and 1 year after operation respectively to analyze the influence of changes of joint line after TKA on anterior knee pain.Results At 1 year after operation,the knee score,knee joint function score and Feller patella score were(90.7±3.3),(77.8±3.9)and(26.9±3.5)points,which were higher than those of(57.7±4.6),(47.2±4.0)and(10.9±2.3)points before operation.The difference was statistically significant(P<0.05).The level of the knee joint line changed from-5.0 to 10.0(2.09±4.0)mm.The joint line increased in 58 knees and decreased in 22 knees.Among them,21 knees had change in knee joint line>4 mm,and 8 knees had anterior knee pain;8 knees had change in knee joint line≤4 mm and 2 knees had anterior knee pain.Before operation,the knee score,knee joint function score and Feller patella score of joint line elevation>4 mm were(57.3±4.8),(47.9±3.6)and(10.5±2.5)points;the knee score,knee joint function score and Feller patella score of patients with change in knee joint line≤4 mm were(57.5±5.0),(45.6±4.0)and(10.5±1.9)points.At 1 year after operation,the knee score,knee joint function score and Feller patella score of patients with change in knee joint line>4 mm were(90.5±3.3),(77.5±3.9)and(24.7±4.8)points;the knee score,knee joint function score and Feller patella score of patients with change in knee joint line≤4 mm were(90.0±3.9),(77.3±4.1)and(24.6±3.0)points.The knee score,knee joint function score and Feller patellar score of patients with change of knee joint line≤4 mm and>4 mm before and 1 year after operation were compared,and the differences were statistically significant(P<0.05).Pearson correlation analysis showed that the change of knee joint line>4 mm and Feller patellar score was negatively correlated with the knee joint line change level(r=-0.744,P=0.000<0.05).Change of knee joint line≤4 mm and Feller patellar score had no correlation with knee joint line change level(r=-0.442,P=0.273>0.05).Conclusion The elevation of knee joint line is more common than the decrease after TKA.Anterior knee pain is closely related to the change of knee joint line after TKA.The elevation of knee joint line>4 mm is an important cause of anterior knee pain.