人工髌股关节置换术的早中期随访研究  

Early-and mid-term clinical outcomes of patellofemoral arthroplasty

作　　者：单鹏程[1] 胡佩岩[1] 何名江[1] 张洪美[1] Shan Pengcheng;Hu Peiyan;He Mingjiang;Zhang Hongmei(Department One of Joint Surgery,Wangjing Hospital of China Academy of Chinese Medical Sciences,Beijing 100102,China)

机构地区：[1]中国中医科学院望京医院骨关节一科,北京100102

出　　处：《中华骨科杂志》2022年第13期831-838,共8页Chinese Journal of Orthopaedics

基　　金：首都临床诊疗技术研究及转化应用(Z201100005520058)。

摘　　要：目的探讨人工髌股关节置换术治疗重度髌股关节骨关节炎的早中期疗效。方法回顾性分析2013年1月至2020年12月行髌股关节置换术的严重髌股关节骨关节炎患者64例(80膝), 男9例(12膝)、女55例(68膝);年龄(60.50±8.82)岁(范围27~82岁)。术前膝关节X线片提示髌股关节退变均为Kellgren-Lawrence Ⅳ级, 内外侧胫股间室无明显退变。单侧髌股关节置换48例, 双侧髌股关节置换16例, 其中同期双侧髌股关节置换9例、分次行双侧髌股关节置换7例。对术后随访5年以上的患者采用疼痛视觉模拟评分(visual analogue scale, VAS)、纽约特种外科医院(Hospital for Special Surgery, HSS)膝关节评分及牛津膝关节评分(Oxford knee score, OKS)评估临床疗效;测量手术前后膝关节髌骨轴位X线片上髌骨倾斜角和站立位双下肢全长正位X线片上髋-膝-踝角;观察有无切口感染、假体周围感染、深静脉血栓形成、假体松动、磨损及胫股间室严重骨关节炎等并发症。结果 64例患者随访(4.31±1.79)年(范围1.5~8.2年), 随访5年以上者25例(32膝)。膝关节VAS评分、HSS评分及OKS评分分别由术前(5.91±0.82)分、(68.06±6.03)分和(21.22±3.46)分改善至术后1年(0.88±1.01)分、(90.09±3.30)分和(39.06±3.37)分, 术后5年(0.41±0.76)分、(94.53±2.99)分和(42.13±3.17)分, 手术前后的差异均有统计学意义(F=89.38, 81.47, 56.73;P<0.001)。髌骨倾斜角由术前8.21°±3.14°降低至术后5年的3.58°±4.48°, 差异有统计学意义(t=4.96, P<0.001);术前髋-膝-踝角为179.01°±1.43°、术后5年为178.77°±1.67°, 手术前后的差异无统计学意义(t=1.71, P=0.096)。随访期间所有患者均未出现因假体松动、假体磨损及胫股间室严重骨关节炎而行膝关节翻修的情况。结论髌股关节置换治疗重度髌股关节骨关节炎的早中期随访临床疗效良好, 可以明显缓解膝关节疼痛症状并改善膝关节功能。Objective To investigate the early-and mid-term clinical,functional and radiographic outcomes of patellofemoral arthroplasty(PFA).Methods A retrospective analysis was conducted in 64 patients(80 knees)who suffered from severe patellofemoral osteoarthritis(PFOA)and underwent PFA from January 2013 to December 2020.These patients were aged 60.50±8.82(range from 27 to 82)years,including 9 males(12 knees)and 55 females(68 knees).All enrolled individuals presented typical PFOA.Unilateral PFA was performed in 48 cases,bilateral PFA in 16 cases,including one-stage PFA in 9 cases and two-stage PFA in 7 cases.The visual analogue scale(VAS),Hospital for Special Surgery(HSS)knee score and Oxford knee score(OKS)of patients with more than 5 years'follow-up were assessed to evaluate the clinical effects of PFA at the time before surgery,1 year and 5 years after surgery.In addition,the patellar tilt angle(PTA)and hip-knee-ankle(HKA)angle were measured and analyzed to evaluate the improvement of patellar tracking and progression of tibiofemoral osteoarthritis,based on axial X-ray imaging(skyline view)of knee and the full length standing X-ray imaging of the lower limbs at before surgery and 5 years after surgery.Meanwhile,the complications of all patients that related to the operation were recorded.Results A total of 64 patients were followed up for 4.31±1.79(range,1.5 to 8.2)years.Twenty-five patients(32 knees)who followed up more than 5 years were analyzed.The VAS,HSS and OKS improved from 5.91±0.82,68.06±6.03 and 21.22±3.46 preoperatively to 0.88±1.01,90.09±3.30 and 39.06±3.37 at 1 year after surgery,and to 0.41±0.76,94.53±2.99 and 42.13±3.17 at 5 years after surgery,respectively(F=89.38,81.47,56.73,P<0.001).Additionally,comparing to the preoperative radiological data,the patellar tract was improved with the PTA decreased from 8.21°±3.14°preoperatively to 3.58°±4.48°at 5 years after surgery(t=4.96,P<0.001).The HKA angle changed from 179.01°±1.43°preoperatively to 178.77°±1.67°at 5 years follow up(t=1.71,

关 键 词：髌股关节 骨关节炎 膝 关节成形术 置换 膝 随访研究 

分 类 号：R687.4[医药卫生—骨科学]