初次人工全膝关节置换术中髌骨置换与否对中远期疗效影响的比较研究  

A comparative study of mid-and long-term effectiveness of patellar resurfacing or nonresurfacing in primary total knee arthroplasty

作　　者：刘特 陶冶 宋俊雷[1] 贾承奇 赵润凯 付君 陈继营 倪明 LIU Te;TAO Ye;SONG Junlei;JIA Chengqi;ZHAO Runkai;FU Jun;CHEN Jiying;NI Ming(Department of Orthopedics,the Fourth Medical Center of Chinese PLA General Hospital,Beijing,100048,P.R.China;Medical School of Chinese PLA,Beijing,100853,P.R.China;Department of Orthopedics,Beijing Jishuitan Hospital,Capital Medical University,Beijing,100035,P.R.China)

机构地区：[1]中国人民解放军总医院第四医学中心骨科医学部,北京100048 [2]中国人民解放军医学院,北京100853 [3]首都医科大学附属北京积水潭医院骨科,北京100035

出　　处：《中国修复重建外科杂志》2024年第12期1451-1457,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：北京市自然科学基金-海淀原始创新联合基金项目(L222032)。

摘　　要：目的比较初次人工全膝关节置换术(total knee arthroplasty,TKA)中行髌骨置换与否的中、远期临床疗效。方法以2013年3月—2015年9月行双侧TKA的26例患者为研究对象。随机选择一侧行髌骨置换(置换组),另一侧不行髌骨置换(对照组)。男4例,女22例;年龄51~65岁,平均59岁。Kellgren-Lawrence分级:双膝Ⅳ级21例、Ⅲ级5例。两组手术侧别及术前膝关节协会评分(KSS)的临床和功能评分、疼痛视觉模拟评分(VAS)、术前膝前痛定位点构成比比较差异均无统计学意义(P>0.05)。记录并比较患者双侧手术时间、术中出血量,术后有无髌前弹响、束缚感、髌腱无力、捻发音或握雪感等异常体征,以及并发症发生情况。患者主观评价包括人工关节遗忘评分(FJS)、膝关节高级活动困难程度(包括屈曲负重、上楼、下楼、下蹲起立、下跪、伸膝、盘腿7个项目);采用KSS临床/功能评分及VAS评分评价膝关节功能恢复情况,通过定位图进行膝前痛位置定位。结果置换组手术时间长于对照组(P<0.05),两组术中出血量比较差异无统计学意义(P>0.05)。患者术后切口均Ⅰ期愈合;住院时间8~23 d,平均12.6 d。术后患者均获随访,随访时间9~11年,平均9.7年。除1例因内科疾病导致多器官衰竭于术后9年死亡以及5例影像学资料不全,余20例患者经影像学评估后发现,对照组1侧膝关节发生髌骨脱位;其余患者无假体失败(断裂、松动、移位等)、髌骨骨折、髌骨坏死、髌骨不稳、髌韧带断裂、假体翻修等发生。患者两侧膝关节均无因髌骨相关并发症或膝前痛导致的再次手术。术后2年及末次随访时,两组双膝关节髌前弹响、束缚感、髌腱无力、捻发音或握雪感等异常体征发生率,膝关节高级活动困难发生率,以及膝前痛定位点构成比比较差异均无统计学意义(P>0.05)。两组KSS临床评分、功能评分及VAS评分均较术前显著改善(P<0.05);术�Objective To compare the mid-and long-term effectiveness of patellar resurfacing versus nonresurfacing in primary total knee arthroplasty(TKA).Methods Twenty-six patients who underwent bilateral TKA between March 2013 and September 2015 were selected as the study subjects.One side was randomly chosen for patellar resurfacing(resurfacing group),and the other side was not(control group).There were 4 males and 22 females,the age ranged from 51 to 65 years,with an average of 59 years.According to Kellgren-Lawrence classification,there were 21 cases of gradeⅣand 5 cases of gradeⅢin both knees.There was no significant difference in the surgical side,and preoperative clinical and functional scores of the Knee Society Score(KSS),visual analogue scale(VAS)score,and the composition ratio of anterior knee pain localization points between the two groups(P>0.05).The operation time,intraoperative blood loss,postoperative abnormal signs such as patellar clunk,feeling of constraint,patellar tendon weakness,crepitus,or snow-on-glass sensation,and the occurrence of complications were recorded and compared.Patient subjective evaluations included Forgotten Joint Score(FJS)and the degree of difficulty in high-level knee activities(including flexion with load bearing,going upstairs,going downstairs,squatting and standing up,kneeling,knee extension,and crossing legs for 7 items);KSS clinical/functional scores and VAS scores were used to evaluate the recovery of knee joint function,and the location of anterior knee pain was determined by a localization diagram.Results The operation time of the resurfacing group was significantly longer than that of the control group(P<0.05),and there was no significant difference in intraoperative blood loss between the two groups(P>0.05).All patients’incisions healed by first intention;the hospital stay ranged from 8 to 23 days,with an average of 12.6 days.All patients were followed up 9-11 years,with an average of 9.7 years.Except for 1 case who died of multiple organ failure due to internal dis

关 键 词：膝骨关节炎 人工全膝关节置换术 髌骨置换 

分 类 号：R687.4[医药卫生—骨科学]