全膝关节置换术中髌骨成形联合髌骨减压对早期功能及膝前痛的影响  

Efficacy of patellar decompression with patelloplasty on improving knee function in total knee arthroplasty

作　　者：程鹏[1] 王永清[2] Kifayatullah 王业林[2] 

机构地区：[1]天津医科大学第四中心临床学院骨科,天津300143 [2]天津市第四中心医院骨科,天津300143

出　　处：《天津医科大学学报》2016年第6期509-513,共5页Journal of Tianjin Medical University

摘　　要：目的： 探讨髌骨减压术与髌骨成形术对全膝关节置换术（TKA）后早期膝关节功能及膝前痛发生率的影响。方法：回顾性分析2010年8月至2012年8月因膝关节骨关节炎行初次全膝关节置换的74例患者的病例资料，男20例，女54例；年龄48~80岁，平均（63.4±8.3）岁。依据不同手术方式将患者分为髌骨成形组（36膝）、髌骨减压组（38膝）。患者均使用相同类型的关节假体，由同一组医师完成手术。术后膝前痛采用VAS评分，髌骨功能使用Feller评分。两组患者术前一般资料、美国膝关节协会（KSS）膝评分及功能评分均无统计学差异。比较两者术后1个月、3个月、6个月、12个月的KSS膝评分、功能评分、Feller髌骨评分及术后膝前痛发生率。结果： 两组KSS膝评分术后各时点的差异均无统计学意义。术后6个月、12个月的KSS功能评分和Feller髌骨评分，髌骨减压组优于髌骨成形组，差异有统计学意义。术后12个月膝前痛发生率分别为30.6%（11/36），10.5%（4/38），两组间差异有统计学意义。结论：膝关节骨关节炎患者行保留髌骨TKA可改善膝关节功能和降低膝前痛发生率；TKA术中联合髌骨减压相比单纯髌骨成形可提高术后短期疗效，应用此技术可明显降低膝前痛发生率。Objective ：To compare the effects of patelloplasty and patellar decompression on knee function in total knee arthroplasty（TKA）. Methods：A total number of 74 patients （20 males, 54 females）with knee osteoarthritis who underwent primary TKA from August 2010 to August 2012 were retrospectively analyzed. Their ages ranged from 48 to 80 years with the average age of （63.4±8.3） years. The patients were divided into two groups according to different treatments： TKA with patelloplasty（36 patients, 36 knees）and TKA with patellar decompression（38 patients, 38 knees）. All the procedures were performed by the same group of surgeons and the same type of prostheses（GenesisII, Simths＆Nephews, USA）were implanted. Their data was evaluated, including patellar rating by Feller patella score, and anterior knee pain by visual analogue scores （VAS）. There was no significant difference between the two groups in general data and the American Knee Society Score （KSS）. Every patient was followed up for 4 weeks, 3 months, 6months, one year. The patients were assessed according to the Knee Society rating, clinical anterior knee pain score in each group. Results： There were no statistical differences between the two groups in KSS knee score. The results in KSS function score and Feller’s patella score were statistically higher in the decompression group than the patelloplasty group at the time of 6 months and 12 months after the operation. The postoperative incidence of anterior knee pain was found to be 30.6%（11/36）, 10.5%（4/38）, respectively. They were significantly different from one another. Conclusion ： Total knee arthroplasty with patellar retention can improve knee function and decrease the incidence of anterior knee pain after the operation. Patella decompressing during TKA could result in higher function score of knee joint and lower incidence of anterior knee pain than simply using patelloplasty with TKA.

关 键 词：关节成形术 膝关节 膝前痛 髌骨 

分 类 号：R684.3[医药卫生—骨科学]