老年固定性髌脱位骨关节炎髌骨旷置全膝置换  

Total knee arthroplasty with patellar exclusion for osteoarthritis with permanent irreducible dislocation of patella in elderly

作　　者：李浪 李强 黄奇 邓立庆 万莎 LI Lang;LI Qiang;HUANG Qi;DENG Li-qing;WAN Sha(Chengdu Hospital of the People's Government of Tibet Autonomous Region,Chengdu,610041,China)

机构地区：[1]西藏自治区人民政府驻成都办事处医院,四川成都610041

出　　处：《中国矫形外科杂志》2023年第21期1991-1993,1997,共4页Orthopedic Journal of China

基　　金：西藏自治区科技计划项目-重点研发计划项目(编号:XZ202201ZY0041G);西藏自治区科技计划项目-中央引导地方项目(编号:XZ202001YD0026C)。

摘　　要：[目的]介绍老年固定性髌脱位骨关节炎髌骨旷置全膝置换(total knee arthroplasty,TKA)的手术技术及初步疗效。[方法]对4例(5膝)老年膝骨关节炎(knee osteoarthritis,KOA)伴固定性髌骨脱位患者,采用限制性假体行TKA。沿髌骨内侧切开关节囊,髌骨予以修整成形,去神经化,并做外侧支持带松解,判断髌骨仍无法复位,将髌骨旷置于外侧间沟,股骨和胫骨端截骨后,分别安装假体,缝合切口。[结果]所有患者均顺利完成手术,术中无并发症。随访时间平均(4.0±0.8)年,与术前相比,末次随访VAS评分[(7.0±0.9),(1.1±0.9),P<0.001]和HSS评分[(29.9±5.5),(79.2±3.6),P<0.001]均显著改善。末次随访时,伸膝肌力均为4级,患者均可正常行走,但卧位状态下仍有10°~25°的伸膝迟滞,所有患者未见假体松动。[结论]对于老年膝关节OA伴固定性髌骨脱位,若患者功能需求不高,TKA术中可采用髌骨旷置,疗效满意,可作为临床治疗的一种选择。[Objective] To introduce the surgical technique and preliminary outcome of total knee arthroplasty(TKA) with patellar exclusion for knee osteoarthritis(KOA) accompanied with fixed patellar dislocation.[Methods] Four elderly patients(5 knees) underwent TKA with patellar exclusion using restrictive prosthesis for KOA with fixed patellar dislocation.The joint was opened by anteromedial incision,the patella was trimmed and shaped,denervated,and the lateral retinaculum was released.As judging that the patella could not be reduced,and the patella was left in situ.After the femoral and tibial osteotomies were conducted correctly,the prosthetic components were installed respectively,and the incision was sutured.[Results] All patients had TKA performed successfully without serious complications,and followed up for(4.0±0.8) years on an average.Compared with those preoperatively,the VAS score [(7.0±0.9),(1.1±0.9),P<0.001] and HSS score[(29.9±5.5),(79.2±3.6),P<0.001] improved significantly at the latest follow-up.All the patients had knee extensor muscle strength of grade4,and could walk normally,whereas with knee extension sag of 10°~25° in the decubitus position.No prosthesis loosening was observed in anyone of them.[Conclusion] For the elderly knee OA with fixed patellar dislocation,TKA can be performed with patellar exclusion if the functional needs of patients are not high,which does achieve satisfactory clinical outcomes,and should be used as a choice for this scenario.

关 键 词：固定性髌骨脱位 膝骨关节炎 髌骨旷置 全膝关节置换术 老年人 

分 类 号：R684.4[医药卫生—骨科学]