髌骨部分切除患者膝关节远期功能与影像学改变研究  

Long-term function and imaging changes of the knee in patients with partial patellectomy

作　　者：朱炼[1] 王海立[1] 李旭[1] 陈伟[1] 邢欣[1] 张琦[1] 董天华[1] 张英泽[1] 

机构地区：[1]河北医科大学第三医院创伤急救中心、河北省骨科生物力学重点实验室,石家庄050051

出　　处：《中华创伤骨科杂志》2013年第11期924-927,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨髌骨部分切除患者膝关节的远期功能和影像学改变。方法回顾性分析1987年1月至2002年1月期间行髌骨部分切除的29例髌骨骨折患者资料，男21例，女8例；平均年龄为45．8岁（29～71岁）。末次随访时对所有患者进行磁共振成像（MRI）检查、膝关节功能检查和问卷调查，采用改良Whole—Organ磁共振成像评分（WORMS）对患者的MRI进行分析，并应用膝关节损伤和骨关节炎评分（KOOS）及Bostman髌骨骨折疗效评价标准对膝关节功能进行评估。结果29例患者术后获8～18年（平均13年）随访。末次随访时29例患者患侧膝关节改良WORMS评分平均为（13．8±5．8）分，轻度关节炎24例，中度5例；健侧改良WORMS评分平均为（12．3±5．5）分，轻度关节炎28例，中度1例，两侧比较差异无统计学意义（t=1．001，P=0．321）。KOOS评分中疼痛评分平均为（88．0±6．4）分、症状为（86．9±5．7）分、日常生活活动为（89．9±5．2）分、娱乐及运动功能为（83．6±7．6）分、膝关节相关生活质量为（80．5±8．5）分。Bostman髌骨骨折疗效评价标准评分平均为27．4分，优良20例，一般9例。患侧膝关节平均屈曲为128．3°±5．5°，健侧为128．8°±4．2°；患侧膝关节伸膝峰扭矩平均为（105．4±12．2）N·m，健侧为（106．6±9．1）N·m，以上项目两侧比较差异均无统计学意义（P〉0．05）。结论髌骨部分切除术不会造成严重的髌股关节退变和创伤性关节炎，膝关节功能评分显示远期疗效优良。对于难以复位和复位不良的髌骨骨折，可行髌骨部分切除术。Objective To investigate the long-term function and imaging changes of the knee in patients with partial patellectomy. Methods From January 1987 to January 2002, 29 patients underwent partial patellectomy in our hospital. They were 21 men and 8 women, with an average age of 45.8 years （range, 29 to 71 years）. At the last follow-up, the knee function of all the patients was examined by MRI and physical examinations and questionnaire. The MRI results were evaluated by modified Whole-Organ Magnetic Resonance Imaging Score （WORMS） of the knee. The knee function was also assessed by Knee Injury and Osteoarthritis Outcome Score （KOOS） and Bostman＇s Score. Results The 29 patients were followed up for 8 to 18 years （average, 13 years）. The average modified WORMS score of the affected knee was 13.8 ± 5.8 points in 24 cases of mild and 5 cases of moderate arthritis; the score of the unaffected side was 12.3 ± 5.5 points in 26 cases of mild and 3 cases of moderate arthritis. There was no statistically significant differ- ence between the 2 groups （ t = 1. 001, P =0. 321）. The average KOOS for pain was 88.0 ±6. 4 points, for symptom 86. 9 ± 5.7 points, for daily life 89.9 ± 5.2 points, for entertainment and sports 83.6 ± 7.6 points, and for the quality of life related to knee joint function 80.5 ± 8.5 points. The average Bostman＇s score was 27.4 points in 20 excellent to good patients and 9 moderate ones. The flexion was 128.3~ ~ 5.5~ for the in- volved side and 128.8°±4.2° for the uninvolved knee; the peak torque averaged 105.4 ± 12. 2 N · m for the involved side and 106.6 ± 9. 1 N· m for the uninvolved knee. There were no statistically significant differ- ences regarding the above 2 parameters between the 2 sides （ P 〉 0.05） . Conclusions Partial patel- lectomy may not cause serious joint degeneration or traumatic arthritis, for its long-term outcomes are fine. This procedure can be used for patellar fractures whose reduction is difficult or unsatisfactory.

关 键 词：髌骨 骨折 治疗结果 部分切除 

分 类 号：R687.3[医药卫生—骨科学]