全膝关节置换术中髌骨置换及髌骨高度对术后疗效的影响  

Effects of patellar replacement and height on treatment outcomes of total knee arthroplasty

作　　者：刘一帆 张文强 张明 刘毅 蒋洪宇 孙韬 Liu Yifan;Zhang Wenqiang;Zhang Ming;Liu Yi;Jiang Hongyu;Sun Tao(Department of Orthopaedics,the First Afiliated Hospital of Shandong First Medical University,Jinan 250014,China;Shandong First Medical University,Jinan 250117,China)

机构地区：[1]山东第一医科大学第一附属医院骨关节外科,济南250014 [2]山东第一医科大学,济南250117

出　　处：《中华骨科杂志》2023年第18期1208-1214,共7页Chinese Journal of Orthopaedics

基　　金：山东省自然科学基金面上项目(ZR2022MH299)。

摘　　要：目的探讨全膝关节置换术(total knee arthroplasty,TKA)中行髌骨置换与否及术前髌骨高度对疗效的影响。方法回顾性分析2020年7月至2021年12月山东第一医科大学第一附属医院采用TKA治疗的膝关节严重骨关节炎患者429例,男92例、女337例;年龄(66.81±7.05)岁,左侧226例、右侧203例,体质指数(27.60±4.22)kg/m^(2),Kellgren-Lawrence分级均为Ⅲ级,Insall-Salvati(IS)比值>0.8。按是否行髌骨置换及术前IS比值(IS为0.8~1.2为正常高度髌骨、>1.2为高位髌骨)将患者分为四个组:髌骨置换+正常高度髌骨组(263例)、髌骨置换+高位髌骨组(66例)、髌骨未置换+正常高度髌骨组(68例)、髌骨未置换+高位髌骨组(32例)。比较组间术后IS比值、美国膝关节协会评分(Knee Society Score,KSS)、美国特种外科医院(Hospital for Special Surgery,HSS)膝关节评分、牛津膝关节评分(Oxford Knee Score,OKS)、膝关节活动度、并发症和满意度。结果所有患者均获得随访,随访时间为(1.15±0.16)年(范围1~2年);术后膝关节疼痛、肿胀、活动受限等症状均较术前明显改善。四组患者KSS疼痛评分、膝关节活动度、HSS评分、OKS评分的组间差异均有统计学意义(F=9.49,P<0.001;F=11.09,P<0.001;F=6.74,P<0.001;F=3.24,P=0.022),但KSS功能评分的差异无统计学意义(F=1.84,P=0.140)。髌骨置换+正常高度髌骨组的KSS疼痛评分、HSS评分、OKS评分、膝关节活动度[(41.84±5.25)分、(80.43±6.99)分、(14.27±5.39)分、122.33°±4.93°]均优于髌骨未置换+正常高度髌骨组[(38.31±7.31)分、(77.00±7.81)分、(16.05±5.81)分、120.99°±4.90°]和髌骨未置换+高位髌骨组[(37.97±7.28)分、(75.62±11.02)分、(16.63±6.67)分、116.25°±13.08°],差异均有统计学意义(P<0.05)。髌骨置换+高位髌骨组仅KSS疼痛评分优于髌骨未置换+正常高度髌骨组和髌骨未置换+高位髌骨组[(41.74±6.35)分、(38.31±7.31)分、(37.97±7.28)分],差异均有统计学意义(P<0.05)�Objective To investigate the effect of patellar replacement and patellar height on the therapeutic effect of total knee arthroplasty(TKA).Methods A retrospective analysis was conducted on 429 patients(92 males,337 females;aged 66.81±7.05 years;left=226,right=203)with severe knee osteoarthritis who underwent TKA in the First Affiliated Hospital of Shandong First Medical University from July 2020 to December 2021,with the body mass index of 27.60±4.22 kg/m^(2),Grade-ⅢKell gren-Lawrence,and Insall-Salvati(IS)ratio>0.8.Afterward,the patients were divided into 4 groups according to whether patellar replacement was performed or not and the preoperative IS ratio(IS of 0.8-1.2 for normal patellar and>1.2 for high patellar):the patellar replacement+normal height patellar group(263 cases),the patellar replacement+high height patellar group(66 cases),the patellar non-replacement+normal height patellar group(68 cases),and the patellar non-replacement+high height patellar group(32 cases).Moreover,postoperative intergroup IS ratio,Knee Society Score(KSS),Hospital for Special Surgery(HSS)knee score,Oxford Knee Score(OKS),knee range of motion,complications,and satisfaction were analyzed.Results All patients were followed up,and the time was 1.15±0.16 years(range,1-2 years).Postoperative symptoms such as knee pain,swelling,and limitation of movement were significantly improved compared with the preoperative period.Additionally,KsS pain score,knee range of motion,HSS score and 0KS score were significantly different among the four groups(F=9.49,P<0.001;F=11.09,P<0.001;F=6.74,P<0.001;F=3.24,P=0.022),but the difference in KSS functional scores was not statistically significant(F=1.84,P=0.140).At the same time,the KSS pain score,HSS score,OKS score,and knee range of motion(41.84±5.25,80.43±6.99,14.27±5.39,and 122.33°±4.93°)in the patellar replacement+normal height patella group were all better than those in the patellar non-replacement+normal height patella group(38.31±7.31,77.00±7.81,16.05±5.81,120.99°±4.90°)and pate

关 键 词：骨关节炎 膝 关节成形术 置换 膝 髌骨 

分 类 号：R687.4[医药卫生—骨科学]