双膝关节置换术中髌骨置换与否的左右侧随机对照研究  

Unilateral patellar resurfacing in bilateral total knee arthroplasty:a randomized controlled study

作　　者：王军锋[1,2] 李沼 张克石[1] 袁峰 李儒军[1] 钟群杰[1] 关振鹏[1] 

机构地区：[1]北京大学人民医院关节病诊疗研究中心,北京100044 [2]北京大学国际医院骨科,北京102206

出　　处：《北京大学学报（医学版）》2017年第5期861-866,共6页Journal of Peking University:Health Sciences

基　　金：国家自然科学基金资助(81371925)~~

摘　　要：目的:双膝关节置换术中随机选择一侧置换髌骨,对侧保留髌骨,对比研究髌骨置换与否对术后临床效果的影响。方法:共入选14例双膝骨关节炎患者,28个膝,均为女性,年龄为53~78岁,平均(66.9±7.8)岁,体重指数为(26.3±1.8)kg/m2。随机分组为拟行左侧或右侧髌骨置换和对侧髌骨保留,术后均获随访,随访时间为3~12个月。随访时记录患者手术前后双膝美国膝关节协会评分(American Knee Society score,KSS)、关节活动度(range of motion,ROM)、术后髌骨倾斜角(patellar tilt angle,PTA)、有无术后膝前痛及髌骨弹响、有无术后膝关节并发症等。结果:术后切口均一期愈合,无感染、松动、髌骨骨折等并发症发生。髌骨置换侧KSS评分由术前的(38.9±22.2)分提高至(92.4±6.7)分,术后较术前KSS增加值为(53.5±20.3)分;保留髌骨侧KSS评分由术前的(38.4±20.5)分提高至(92.1±4.2)分,术后较术前KSS增加为(53.7±21.4)分,两组间KSS评分的增加差异无统计学意义(P=0.98)。髌骨置换侧关节活动度由术前的95.4°±13.5°提高至120.4°±8.9°,术后ROM较术前增加为25.0°±14.5°;保留髌骨侧ROM由术前的92.9°±19.1°增加至120.4°±8.4°,术后较术前ROM增加为27.5°±19.4°,两组间ROM的增加差异也无统计学意义(P=0.70)。术后随访时,患者髌骨置换侧出现膝前痛共3膝(占21.4%),而保留髌骨侧膝前痛共出现2膝(占14.3%),两组间膝前痛的发生率比较差异无统计学意义(P=0.62)。术后髌骨置换侧出现髌骨弹响共3膝(占21.4%),保留髌骨侧3膝(占21.4%),组间比较差异无统计学意义。髌骨置换侧术后PTA为2.6°±2.6°,保留髌骨侧为3.6°±2.9°,两者间差异无统计学意义(P=0.36)。结论:全膝关节置换术中,对于髌骨关节面轻中度破坏的骨关节炎患者,髌骨置换较髌骨保留在术后膝前痛、髌骨弹响的发生率、术后关节功能改善及髌股轨迹等方面并无明显优势。Objective: To perform unilateral patellar resurfacing and contralateral patellar retention in bilateral total knee arthroplasty( TKA) randomly,and to compare the clinical effects of patellar retention with patellar resurfacing in TKA. Methods: In the study,14 bilateral knee osteoarthritis( OA) patients were randomized in the bilateral TKA to receive unilateral patellar resurfacing and contralateral patellar retention,including 28 knees,all were females,53 to 78 years old,with average( 66. 9 ± 7. 8) years,and the BMI was( 26. 3 ± 1. 8) kg/m2. All subjects were followed up from 3 to 12 months. The clinical effects were evaluated based on measurements of American Knee Society score( KSS),range of motion( ROM),anterior knee pain,patellar clunk,and patellar tilt angle( PTA). Results: All the wounds healed primarily without significant complications,such as infection,aseptic loosening,patellar fracture and so on. The preoperative KSS scores of patellar resurfacing group were 38. 9 ± 22. 2,and the scores changed to be 92. 4 ± 6. 7 after operation,which were added by 53. 5 ± 20. 3. While in the patellar retention group,the KSS scores were 38. 4 ± 20. 5 preoperatively,and after operation,which were added to be 92. 1 ± 4. 2,and improved by 53. 7 ± 21. 4. The differences in the changed KSS scores between TKA with and without patellar resurfacing were not statistically significant( Independent t-test,P = 0. 98).The ROM was changed from 95. 4° ± 13. 5° preoperatively to 120. 4° ± 8. 9° postoperatively in the patellar resurfacing group and from 92. 9° ± 19. 1° preoperatively to 120. 4 ± 8. 4° postoperatively in the patellar retention group. The ROM of the two group were increased by 25. 0° ± 14. 5° and 27. 5° ± 19. 4° respectively. However,no remarkable differences were observed between the 2 groups in the knee ROM( Independent t-test,P = 0. 70). At the end of the latest follow-up,3 knees in the patellar resurfacing group and 2 knees in the patellar retention group had knee anterior pain,the incidences

关 键 词：全膝关节置换术 髌骨置换 髌骨保留 

分 类 号：R687.4[医药卫生—骨科学]