人工全膝关节置换术中髌骨未置换对疗效的影响  

EFFECT OF PATELLAR NON-RESURFACING ON CLINICAL RESULTS AFTER TOTAL KNEE ARTHROPLASTY

作　　者：阿吉木.克热木 买买提艾力.哈斯木 单平联[1] 阿不都.艾拉 

机构地区：[1]喀什地区第一人民医院骨一科,新疆喀什844000 [2]新疆医科大学附属肿瘤医院骨科

出　　处：《中国修复重建外科杂志》2013年第10期1157-1161,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨采用旋转活动平台假体行人工全膝关节置换术（total knee arthroplasty，TKA）中髌骨未置换对术后疗效的影响。 方法回顾分析2008 年 4 月－2011年 4月采用旋转活动平台假体行TKA且髌骨未置换的 163 例膝关节退变性骨关节炎患者临床资料。男65例，女98例；年龄54～78岁，平均63岁。术中髌骨软骨退变根据Outerbridge分级标准：Ⅰ级22例，Ⅱ级38例，Ⅲ级64例，Ⅳ级39例。各级患者间性别、年龄及侧别比较，差异均无统计学意义（P 〉 0.05）。记录术中止血带使用时间以及相关并发症发生情况，膝关节功能采用美国膝关节学会评分系统（KSS）和髌骨评分（PS）评定，患者满意度以及膝前痛采用疼痛视觉模拟评分（VAS）评估；常规摄X线片，观察假体及髌骨位置。 结果术中止血带使用时间为90～150 min，平均125 min；术后切口均Ⅰ期愈合，无早期相关并发症发生。患者均获随访，随访时间2～5年，平均3.6年。术后6个月及末次随访时，患者KSS及PS评分均较术前显著提高（P 〈 0.05）；术后6个月及末次随访时比较，差异无统计学意义（P 〉 0.05）。不同髌骨软骨退变等级患者间，术前KSS及PS评分比较差异有统计学意义（P 〈 0.05），但末次随访时比较差异均无统计学意义（P 〉 0.05）。末次随访时，7例患者出现持续膝前痛，根据VAS评定标准评定为轻度疼痛5例，中度2例；患者满意度评价：非常满意90例，满意66例，不确定5例，不满意2例。不同髌骨软骨退变等级患者间满意度及膝前痛比较，差异均无统计学意义（P 〉 0.05）。 结论采用旋转活动平台假体行TKA时髌骨未置换对术后疗效无明显影响。ObjectiveTo evaluate the influence of patellar non-resurfacing on the effectiveness after total knee arthroplasty （TKA）. MethodsBetween April 2008 and April 2011, 163 patients with degenerative osteoarthritis of the knee underwent TKA without patellar resurfacing, and the clinical data were retrospectively analyzed. There were 65 males and 98 females, with a mean age of 63 years （range, 54-78 years）. According to Outerbridge classification for cartilage degeneration, 22 cases were classified as grade I, 38 cases as grade II, 64 cases as grade III, and 39 cases as grade IV. There was no significant difference in gender, age, and sides among patients at 4 grades （P 〉 0.05）. The intraoperative tourniquet-using time and postoperative complications were recorded; the knee society score （KSS）, patella score （PS）, patients’ satisfaction, and anterior knee pain [using visual analogue scale （VAS）] were used to evaluate the knee function. X-ray films were routinely taken to observe the position of the prosthesis and the patella. ResultsThe mean tourniquet-using time was 125 minutes （range, 90-150 minutes）. All incisions obtained healing by first intention, and no early postoperative complication occurred. All patients were followed up 2-5 years （mean, 3.6 years）. The KSS and PS scores were significantly improved at 6 months and last follow-up when compared with preoperative scores （P 〈 0.05）, but no significant difference between at 6 months and last follow-up （P 〉 0.05）. Significant differences in KSS and PS scores were found among patients with different grades of cartilage degeneration at preoperation （P 〈 0.05）, but no significant difference at last follow-up （P 〉 0.05）. At last follow-up, 7 patients experienced anterior knee pain （mild pain in 5, moderate pain in 2）. The results of satisfaction were very satisfied in 90 cases, satisfied in 66 cases, not certain in 5 cases, and not satisfied in 2 cases. No significant difference was found in satisfaction a

关 键 词：人工全膝关节置换术 髌骨置换 骨关节炎 

分 类 号：R687.4[医药卫生—骨科学]