关节置换前后髌骨高度对膝关节功能的影响  

The Effects of Preoperative and Postoperative Patellar Position on Postoperative Knee Joint Function

作　　者：郑瑜峰 郭凯[2] 杨宏庆 靳雷[1] 郑联合[1] 丁勇[1] 马保安[1] 

机构地区：[1]第四军医大学唐都骨科医院,陕西西安710038 [2]第四军医大学西京骨科医院,陕西西安710032 [3]潼关县人民医院骨科,陕西渭南714300

出　　处：《现代生物医学进展》2014年第26期5063-5067,共5页Progress in Modern Biomedicine

基　　金：国家自然科学基金面上项目(81371926)

摘　　要：目的:研究全膝关节置换术前、术后Insall-Salvati指数和改良Insall-Salvati指数与术后膝关节活动度的关系。方法:采用HSS评分系统对患者全膝关节置换术后半年至一年的关节功能、活动度、肌力、屈曲畸形、稳定性等进行评价。测量81例(106膝)患者术前、术后X线片Insall-salvati指数及改良Insall-salvati指数。结果:术后HSS评分为(89±10)分,术前Insall-salvati指数及改良Insall-salvati指数分别为(1.00±0.13)、(1.61±0.21),术后Insall-salvati指数及改良Insall-salvati指数分别为(0.94±0.19)、(1.67±0.34)。关节置换术后Insall-salvati指数较置换前显著降低(P<0.05),改良Insall-salvati指数显著提高(P<0.05)。术后低位髌骨组(Insall-salvati指数<0.8)HSS评分、活动度和屈曲畸形分值均较正常髌骨组(0.8<Insall-salvati指数<1.5)显著降低(P<0.05)(P>0.05)。高位髌骨组(Insall-salvati指数>1.5)和正常髌骨组各项评分均无显著差异(P>0.05)。术前改良Insall-salvati指数小于1.8的患者术后膝关节HSS评分、功能、活动度、肌力、屈曲畸形、稳定性显著高于大于1.8的患者(P<0.05)。结论:术前改良Insall-salvati指数和术后Insall-salvati指数可作为评价术后膝关节功能的参考指标。术前、术后的膝关节高度均会影响术后关节功能,全膝关节置换术中精确截骨对术后关节功能十分重要。Objective： To study the relationship between preoperative and postoperative Insall-Salvati ratio, modified Insall-Salvati ratio and postoperative knee joint fimction. Methods： The Hospital for Special Surgery （HSS） score was used to evaluate the joint function, activity, myodynamia, flexion deformity, stability, etc between half a year and one year after total knee replacement. The preoperative and postoperative Insall-Salvati ratio, modified Insall-Salvati ratio of 81 patients （106 knee joint） on X ray were measured, Results： The postoperative HSS score was （89± 10）. The preoperative Insall-Salvati ratio and modified Insall-Salvati ratio were （1.00±0.13） and （1.61 ± 0.21）, while the postoperative Insall-Salvati ratio and modified Insall-Salvati ratio were （0.94± 0.19） and （1.673±0.34）. The postoperative Insall-Salvati ratio significantly increased as compared with the preoperative Insall-Salvati ratio （P〈0.05）, while the postoperative modified Insall-Salvati ratio significantly decreased as compared with the preoperative modified Insall-Salvati ratio（P〈0. 05）. The postoperative HSS score, range of motion score and flexion contracture score significantly decreased in postoperative patella baja （Insall-salvati ratio〈0.8） when compared with that in postoperative normal patella （0.8〈Insall-Salvati ratio〈1.5）（P〈0.05）. There was no significant difference between patella alta（Insall-salvati ratio〉l.5） and normal patella（P〉0.05）. The postoperative HSS score, range of motion score, stability score, functional score, quadriceps strength score, flexion contraeture score of patients whose preoperative modified Insall-salvati ratio were higher than 1.8 significantly increased, when compared with that of patients whose preoperative modified Insall-salvati ratio were lower than 1.8 （P〈0.05）. Conclusion： Preoperative modified Insall-salvati ratio and postoperative Insall-salvati ratio could be considered as reference index of postoperativ

关 键 词：Insall-Salvati指数 改良Insall-Salvati指数 全膝关节置换术 髌骨 

分 类 号：R687.4[医药卫生—骨科学]