全膝关节置换术中髌骨面修整与髌骨置换的比较研究  

Patella reshaping versus resurfacing in total knee arthroplasty:a prospective randomized study

作　　者：刘忠堂[1] 吴宇黎[2] 李晓华[2] 钱齐荣[2] 祝云利[2] 吴海山[2] 

机构地区：[1]温州医学院第二附属医院骨科 [2]第二军医大学长征医院骨科,上海200003

出　　处：《中华外科杂志》2007年第16期1087-1090,共4页Chinese Journal of Surgery

摘　　要：目的比较全膝关节置换术髌骨面修整和髌骨置换的临床结果。方法 2002年1月至12月对60例(60膝)行初次全膝关节置换术的骨性关节炎患者进行前瞻性、随机化研究。所有患者接受相同的后交叉韧带替代型全膝关节假体(PFC),患者随机行髌骨面修整(髌骨面修整组)或髌骨置换(髌骨置换组)。58例患者平均随访54个月(40～60个月),对其进行临床评价,包括膝关节协会评分(KSS)、膝关节活动度(ROM)、患者满意度和 X 线检查。结果两组患者 KSS 总评分(P=0.12)、KSS 疼痛评分(P=0.90)、患者满意度(P=0.22)无明显差异;两组术后膝前痛的发生率均为10%亦无明显差异。两组 ROM(P=0.028)和 KSS 功能评分(P=0.0098)差异有统计学意义。结论全膝关节置换术不论是髌骨面修整还是髌骨置换均能明显减轻疼痛和改善功能。术后膝前痛可能与假体设计和手术技术有关,并非与是否置换髌骨有关。Objective To investigate the differences in the clinical outcome of total knee arthroplasty according to patellar reshaping or resurfacing. Methods From January 2002 to December 2002, 60 patients （60 knees） undergoing primary total knee arthroplasty for the treatment of osteoarthritis were enrolled in a prospective, randomized study. All patients received the same posterior-erueiated-substituting total knee prosthetic components. Patients were randomized to the treatment with reshaping or resurfacing of the patella, and the results were followed up for a mean of 54 months （40-60 months）. Evaluations consisted of the determination of a Knee Society Score, range of motion for knees, patient satisfaction, and radiographs. Results With the numbers available for study, no significant difference was found between the knees that had patellar resurfacing and those that had patellar reshaping with regard to the overall seore（P = 0. 12） ,the subseore for pain （P = 0. 90 ）, and patient satisfaction （P = 0. 22 ）. The results showed that the same prevalence of any anterior knee pain in two groups was 10%, and it did not represent a significant difference. The two groups showed statistical difference with regard to the total function score and range of motion. Conclusions It has shown that total knee arthroplasty with patella reshaping or resurfacing dramatically relieves pain and improves the function. It seems that postoperative anterior knee pain is related either to the component design or to the details of the surgical technique, rather than to whether or not the patella is resurfaced.

关 键 词：关节成形术 置换 膝 髌骨 修整 前瞻性研究 随机对照试验 

分 类 号：R687.4[医药卫生—骨科学]