全膝关节置换术中髌股关节轨迹不良的处理策略及疗效探讨  

Treatment Strategy for Poor Trajectory of Patellofemoral Joint in Total Knee Arthroplasty and the Effect of the Treatment

作　　者：陈斌伟[1] 廖壮文[1] 刘圣曜 李菊根[1] Chen Binwei;Liao Zhuangwen;Liu Shengyao;Li Jvgen(Department of Orthopedics,The Second Affiliated Hospital of Guangzhou Medical University,Guangzhou City,Guangdong 510260,China)

机构地区：[1]广州医科大学附属第二医院骨外科,广东广州510260

出　　处：《中国烧伤创疡杂志》2020年第3期191-194,共4页The Chinese Journal of Burns Wounds & Surface Ulcers

基　　金：广东省科学技术厅科技计划项目(2017ZC0247)

摘　　要：目的总结分析全膝关节置换术(total knee arthroplasty,TKA)中髌股关节轨迹不良的个体化处理策略及其治疗效果。方法选取2012年8月至2017年8月广州医科大学附属第二医院骨外科收治的145例(184膝)拟初次行保留髌骨TKA的膝关节病变患者作为研究对象,术中根据髌股关节轨迹不良情况酌情采用假体位置调整、髌骨修整成形、髌骨内外侧支持带张力调整及Goldthwait-Roux术处理,评估术前及术后疼痛视觉模拟评分法(visual analogue scale,VAS)评分、美国膝关节协会评分(knee society score,KSS)、Feller髌骨评分以及胫骨角、股骨角、胫骨后倾角及股骨屈曲角等假体力线相关参数变化情况,记录假体松动、髌骨坏死、髌骨骨折和骨溶解等并发症发生情况。结果术后所有患者均无假体松动、髌骨坏死、髌骨骨折和骨溶解等并发症发生;随访(16.72±4.16)个月,患者VAS评分明显低于术前(t=38.483,P=0.000),KSS评分、Feller髌骨评分均明显高于术前(t=36.110、17.700,P均=0.000),胫骨角、股骨角、胫骨后倾角、股骨屈曲角均明显大于术前(t=99.997、87.499、14.084、4.101,P均=0.000)。结论 TKA术中根据患者髌股关节轨迹不良情况个性化采用假体位置调整、髌骨修整成形、髌骨内外侧支持带张力调整及Goldthwait-Roux术处理,可纠正患者髌股关节轨迹不良,缓解膝前痛,改善膝关节功能,临床应用价值较高。Objective To analyze the individualized treatment strategy for poor trajectory of patellofemoral joint in total knee arthroplasty(TKA) and the effect of the treatment.Methods 145 patients(184 knees) with knee diseases,admitted to the Department of Orthopedics,The Second Affiliated Hospital of Guangzhou Medical University from August2012 to August 2017 to undergo total knee arthroplasty with patella salvage for the first time,were selected as research subjects.During the surgery,prosthesis position adjustment,patella shaping,adjustment of the tension of medial and lateral retinaculum of patella and the Goldthwait-Roux procedure were conducted based on the condition of patellofemoral joint trajectory.Preoperative and postoperative visual analogue scale(VAS),knee society score(KSS),Feller patellar score and the changes of parameters related to prosthetic alignment,such as sternal angle,femoral horn,posterior tibial angle and femoral angle were evaluated,and the occurrence of complications such as loosening of the prosthesis,patellar necrosis,patellar fracture and osteolysis were recorded.Results After surgery,no complications,such as loosening of prosthesis,patellar necrosis,patellar fracture and osteolysis,were observed in any patients;follow-up(16.72±4.16) months showed that VAS scores after surgery were significantly lower than before surgery(t=38.483,P=0.000),KSS scores and Feller patella scores after surgery were significantly higher than before surgery(t=36.110,17.700,all P=0.000),and tibial angle,femoral angle,posterior tibial angle,femoral flexion angle after surgery were significantly greater than before surgery(t=99.997,87.499,14.084,4.101,all P=0.000).Conclusion During TKA,the following individualized treatment strategies can be adopted based on the condition of patient’s patellofemoral joint trajectory:prosthesis position adjustment,patella shaping,adjustment of the tension of medial and lateral retinaculum of patella and Goldthwait-Roux.These surgeries can correct patient’s patellofemoral joint tra

关 键 词：全膝关节置换术 髌股关节 轨迹不良 髌骨成形 膝前痛 疗效 

分 类 号：R687.4[医药卫生—骨科学]