全膝关节置换术髌骨置换与否的比较

Comparison of total knee replacement with and without patella replacement

目的回顾性分析、比较全膝关节置换术髌骨置换与否的疗效及优缺点,为临床治疗提供参考。方法自1994年1月～2000年12月间住院治疗的骨关节炎及类风湿性关节炎患者86例(109膝)。对髌骨置换和未置换的两组患者进行随访,膝关节评分采用美国HSS评分系统,髌骨评分采用Feller等的髌骨评分标准。随访时拍摄膝关节正、侧位及髌骨30°、90°轴位X线片。结果使用SPSS统计软件进行统计学分析。结果置换组与未置换组术后疗效及并发症的发生率无明显差异,髌骨功能评分差异有非常显著性意义(P<0.01)。置换组部分功能(上下楼梯及从椅子上坐起)略好于未置换组,未置换组术后膝前痛的发生率高于置换组,但多为轻度,差异有显著性意义(P<0.05)。术后髌骨不稳定和半脱位的发生率无统计学差异。结论髌骨不稳定的发生与术前畸形明显及术前髌骨外侧偏移倾向有关,是造成未置换组膝前痛的因素之一。未置换组髌骨不稳定与髌骨分型有关,建议如果术前拍摄髌骨轴位X线片时发现髌骨属于Ⅲ型者应置换髌骨。

Objective To compare retrospectively the clinical outcome of total knee replacement with and without patellar replacement. Methods From January 1994 to December 2000, 109 knees in 86 patients treated for osteoarthritis and rheumatoid arthritis were evaluated postoperatively using a questionnaire and physical examination. There were 17 males and 69 females with the age ranging from 37 to 80 years (average 65.7 years). The osteoarthritis was 8 knees and rheumatoid arthritis 69 knees. Forty-two knees underwent patellar replacement, and 67 knees with reserved patella. The patients were scored using HSS Score for knees and Feller Score for patella. AP and lateral views of the knee as well as 30° and 90° axial views of the patella were taken in radiography .The data were analyzed using SPSS software. Results Replacement and non-replacement groups showed no obvious difference in post-operative knee function and the incidence of complication. The two groups showed statistical significant differences in scoring on climbing and descending stairs and rising from sitting position, the results suggested the replacement group scored slightly better than the nonreplacement group. Post-operative anterior knee pain occurred more commonly in the non-replacement group and showed significant difference (P<0.05) in the two groups. No statistically significant difference in occurrence of patellar instability and subluxation in both procedures. Anterior knee pain occurred more commonly in the non-replacement group, although the pain was mostly mild in degree. Conclusion Occurrence of patellar instability is correlated with preoperative deformity and lateral knee displacement. Patellar instability is a cause of anterior knee pain in the non-replacement group. Patellar instability in the non-replacement group is related to patellar type. Patients with type Ⅲ patella on preoperative axial X-ray have to undergo patellar replacement.