髌股关节置换与全膝关节置换治疗髌股关节骨关节炎的近期疗效比较  

Short-Term Efficacy Comparison of Patellofemoral Arthroplasty and Total Knee Arthroplasty on the Treatment of Severe Patellofemoral Osteoarthritis

作　　者：单鹏程[1] 胡佩岩[1] 何名江[1] 张洪美[1] 艾奇 SHAN Pengcheng;HU Peiyan;HE Mingjiang;ZHANG Hongmei;AI Qi(First Orthopeadic Department,Wangjing Hospital,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：《中国中医骨伤科杂志》2022年第11期44-48,53,共6页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：首都临床诊疗技术研究及转化应用项目(Z201100005520058);首都临床诊疗技术研究及示范应用项目(Z191100006619023)。

摘　　要：目的:比较髌股关节置换术(Patellofemoral Arthroplasty,PFA)和全膝关节置换术(Total Knee Arthroplasty,TKA)治疗严重髌股关节骨关节炎的近期疗效,探讨髌股关节置换术的手术适应证。方法:回顾性分析2017年至2020年行髌股关节置换术和全膝关节置换术手术的严重髌股关节骨关节炎患者87例(96膝),根据手术方式不同分为髌股关节置换术组和全膝关节置换术组,依据两组患者手术时间、术后血红蛋白值降低、异体血输血率、膝关节活动度、疼痛视觉模拟评分(Visual Analogue Scale,VAS)以及美国纽约特种外科医院(Hospital for Special Surgery,HSS)膝关节评分评价髌股关节置换术与全膝关节置换术近期疗效,记录有无手术相关并发症,根据末次随访时膝关节X线片观察有无假体松动、磨损及内外侧胫股间室严重骨关节炎等并发症。结果:髌股关节置换术组和全膝关节置换术组各项术前指标比较差异均无统计学意义(P>0.05),全膝关节置换术组平均手术时间和术后血红蛋白值降低均明显高于髌股关节置换术组,组间比较差异均有统计学意义(P<0.05)。髌股关节置换术组末次随访时膝关节ROM显著高于全膝关节置换术组,组间比较差异有统计学意义(P<0.05)。全膝关节置换术组和髌股关节置换术组两组患者在末次随访时均可获得良好的VAS评分及HSS评分,组间比较差异均无统计学意义(P>0.05)。仅全膝关节置换术组有1例患者接受异体输血治疗,输血率组间比较差异无统计学意义(P>0.05)。两组患者均未出现手术相关并发症及翻修病例。结论:髌股关节置换术和全膝关节置换术治疗严重髌股关节骨关节炎均可获得良好的近期随访临床疗效,髌股关节置换术更推荐用于年轻的单纯髌股关节骨关节炎患者。Objective:To compare the short-term efficacy of patellofemoral arthroplasty(PFA)and total knee arthroplasty(TKA)on the treatment of severe patellofemoral osteoarthritis(PFOA),and discuss the indication of PFA.Methods:87 patients(96 knees)who suffered from severe PFOA and underwent PFA or TKA operation from 2017 to 2020 were retrospectively analyzed.All patients were divided into PFA group and TKA group according to different operation mode.The operation time,postoperative hemoglobin reduction,allogeneic blood transfusion rate,knee joint mobility,visual analogue scale(VAS)and hospital for special surgery(HSS)knee score were used to evaluate the short-term curative efficacy of PFA and TKA and the impact of the two operation modes on the body.Complications such as loosening,abrasive wear of prosthesis and severe osteoarthritis of medial and lateral tibiofemoral compartment according to the X-ray film of knee joint at the last follow-up.Results:There was no difference of any indicator before operation between PFA group and TKA group.However,the operative time and decrease of hemoglobin post-operation were significantly lower in PFA group than those in TKA group(P<0.05),and the ROM of the knee joint post-operation was significantly higher in PFA group(P<0.05).Both PFA group and TKA group achieved excellent VAS and HSS scores,and there was no difference of VAS and HSS scores between the two groups.One patient was accepted allogeneic blood transfusion in TKA group,but there was no difference of blood transfusion rate between two groups(P<0.05).There was no surgical complications and revision cases in both groups.Conclusion:Both PFA and TKA could get excellent short term clinic results on the treatment of severe PFOA,and PFA is recommend to use in younger isolated PFOA patients who has no sign of any joint disease in other compartments.

关 键 词：髌股关节置换 全膝关节置换 髌股关节 骨关节炎 

分 类 号：R687.4[医药卫生—骨科学]