股骨假体设计对保留髌骨全膝关节置换术后膝前痛的影响

The effect of femoral component design on anterior knee pain after patella reserving total knee arthroplasty

目的探讨不同股骨假体设计对保留髌骨全膝关节置换术(totalkneearthroplasty,TKA)后膝前痛发生率及疼痛程度的影响。方法2002年1月15日～2月15日间,门诊共随访保留髌骨TKA后患者44例59膝,所有手术均于1998年10月～2001年10月间施行,术前诊断均为骨关节炎,术后随访3～40个月,平均19.1个月。依据目前较普遍认同的标准:股骨假体髌骨滑槽的深度、宽度、是否对称,髌骨滑槽的延伸范围,股骨假体前方向远端移行是否平滑等将股骨假体分为“髌骨友好”与“髌骨不友好”两组。病例排除的标准:(1)膝关节屈曲小于80°者;(2)X线影像提示存在股骨假体屈曲大于3°、股骨前方皮质切迹(notching)、髌骨高位或低位等外科操作失误者。按美国膝关节学会评分方法及患者自我感觉对疼痛发生率及疼痛程度进行量化分析。结果入选的40例51膝分属上述两组,“髌骨友好”组21膝,术后膝前痛评分平均为1.58(0～8)分;“髌骨不友好”组30膝,术后膝前痛评分平均为3.32(0～6)分,两组之间差异有非常显著性意义(t=4.642,P<0.01)。“髌骨友好”与“髌骨不友好”两组无膝前痛患者构成比分别为64%与9%,两组之间差异有非常显著性意义(χ2=15.457,P<0.01)。结论股骨假体设计的不同会直接影响保留髌骨TKA术后膝前痛的发生率及疼痛程度,行保留髌骨TKA?

Objective To investigate the effect of femoral design on anterior knee pain after patella reserving total knee arthroplasty. Methods From 15 January to 15 February 2002, 44 patients and 59 knees were followed up. Among these patients, 40 patients and 51 knees were included in this study, the rest cases were excluded for one or more of following factors. 1)Knee flexion was less than 80 degrees;2)Radiography showed that there were surgical errors such as: femoral component flexion more than 30, anterior femoral cortex notching, and patellar baja or alta. According to current generally accepted criteria, femoral components were classified as 'Patella Friendly' group and 'Patella Unfriendly' group. The percentage and severity of anterior knee pain was measured with patient visual pain index and Knee Society Functional Score System. Results The aforementioned two groups consisted of 'Patella Friendly' group 21 knees and 'Patella Unfriendly' group 31 knees. The average anterior knee pain score of 'Patella Friendly' group and 'Patella Unfriendly' group was respectively 1.58 (0-8) and 3.32 (0-6). The percentage of pain free patients of the two groups was 64% and 9%. There was significant statistical difference between the groups in terms of anterior knee pain score (t=4.642, P<0.01), and percentage of pain free patients (χ2=15.457, P<0.01). Conclusion Different femoral component design exerts different effect on the incidence and severity of anterior knee pain after patella reserving TKA. One should choose 'Patella Friendly' component while performing patella-reserving TKA. If 'Patella Unfriendly' component is to be used, one should resurface the patella.