全膝关节置换术中髌骨翻转与侧方移位对术后膝关节功能影响的对比分析  

Efficacy of Patellar Turnover versus Lateral Displacement in Total Knee Arthroplasty

作　　者：郭庆华 居宇峰 冯明光 顾小华[1] GUO Qing-hua;JU Yu-feng;FENG Ming-guang;GU Xiao-hua(Department of Joint Surgery,the Seventh Affiliated Hospital of Shanghai Traditional Chinese Medicine University,Shanghai 200137,China)

机构地区：[1]上海中医药大学附属第七人民医院关节外科,上海200137

出　　处：《骨科》2021年第4期329-333,共5页ORTHOPAEDICS

摘　　要：目的分析比较全膝关节置换术(total knee arthroplasty,TKA)中髌骨翻转和髌骨侧方移位对术后膝关节功能的影响。方法回顾性分析2018年1月至2019年12月我科收治的98例因膝关节骨性关节炎行TKA手术治疗病人的临床资料,按术中髌骨处理方式分为翻转组(45例)和侧方移位组(53例)。比较两组病人的手术时间、主动直腿抬高时间、Insall-Salvati指数、膝关节活动度、美国膝关节协会评分(Knee Society score,KSS)、疼痛视觉模拟量表(visual analogue scale,VAS)评分、并发症发生情况等。结果两组的手术时间、术中出血量比较,差异均无统计学意义(P均>0.05)。翻转组的术后直腿抬高时间较侧方移位组明显延长,术后6个月Insall-Salvati指数较侧方移位组明显降低,术后1、2、3、6个月的膝关节活动度、KSS评分均明显低于侧方移位组,VAS评分明显高于侧方移位组,差异均有统计学意义(P均<0.05)。翻转组术后出现3例膝前痛,2例伤口延迟愈合,2例髌骨低位,侧方移位组未见明显并发症发生。结论TKA术中髌骨侧方移位可以减少机体髌韧带及股四头肌损伤,获得满意临床疗效,但有待大样本随机对照研究进一步证实。Objective To analyze and compare the efficacy of patellar turnover vs.lateral patellar displacement on knee replacement in patients undergoing total knee arthroplasty(TKA).Methods The clinical data of 98 patients who received TKA operation for knee osteoarthritis from January 2018 to December 2019 in our department were analyzed retrospectively.The patients were divided into two groups according to the treatment of patella during operation:turnover group(45 cases)and lateral displacement group(53 cases).The operation time,the time of ability to perform an active straight leg raise,Insall⁃Salvati index,knee range of motion,Knee Society score(KSS),visual analogue scale(VAS)score and complications were compared between the two groups.Results There were no significant differences in operation time and intraoperative blood loss between the two groups(both P>0.05).The time of ability to perform an active straight leg raise in the turnover group was significantly longer,the Insall⁃Salvati index was significantly lower at 6th month after operation,the range of motion and KSS score at 1st,2nd,3rd and 6th month after operation were significantly lower,and the VAS score was significantly higher in the turnover group than that in the lateral displacement group(all P<0.05).There were 3 cases of anterior knee pain,2 cases of delayed wound healing and 2 cases of low patellain in the turnover group.No obvious complications occurred in the lateral displacement group.Conclusion Lateral displacement of patella during TKA can reduce the injury of patellar ligament and quadriceps femoris muscle,and obtain satisfactory clinical efficacy.However,further study of large sample randomized controlled study is still needed to confirm.

关 键 词：关节成形术 置换 膝 骨关节炎 髌骨翻转 髌骨侧方移位 

分 类 号：R687.4[医药卫生—骨科学]