全膝关节置换治疗骨关节炎合并固定性髌骨脱位的早期疗效  

Analysis of early-period curative effect of total knee arthroplasty in the treatment of osteoarthritis combined with fixed patellar dislocation

作　　者：陶崎峰[1] 陈春雨 王洪平 兰玉平[1] 张国强[2] Tao Qifeng;Chen Chunyu;Wang Hongping;Lan Yuping;Zhang Guoqiang(Department of Orthopaedics,Panzhihua Central Hospital,Panzhihua 617000,China;Department of Orthopaedics,the First Medi⁃cal Center,General Hospital of the People's Liberation Army,Beijing 100048,China)

机构地区：[1]攀枝花市中心医院骨科,攀枝花617000 [2]解放军总医院第一医学中心骨科,北京100048

出　　处：《中华骨科杂志》2024年第3期146-151,共6页Chinese Journal of Orthopaedics

基　　金：四川省医学会骨科专项课题(2022SAT03);四川省卫生信息学会课题(20230037)

摘　　要：目的探讨全膝关节置换治疗骨关节炎合并固定性髌骨脱位的早期疗效。方法回顾性分析2018年1月至2021年10月于攀枝花市中心医院采用全膝关节置换治疗的骨关节炎合并固定性髌骨脱位患者11例,男4例、女7例,年龄(63.45±4.76)岁(范围56~70岁),均为单侧手术,左膝5例、右膝6例,体质指数(23.20±2.02)kg/m^(2)(范围20.8~27.6 kg/m^(2)),病程(12.63±4.81)年(范围5~21年)。根据美国麻醉医师协会分级,Ⅱ级9例、Ⅲ级2例。全膝关节置换术中均恢复髌骨轨迹,同时采用内侧滑膜瓣转位修复外侧关节囊。比较手术前后膝关节活动度、美国膝关节协会评分(Knee Society score,KSS)、美国加利福尼亚大学洛杉矶分校(University of California Los Angeles,UCLA)活动能力评分、疼痛视觉模拟评分(visual analogue scale,VAS)。结果11例患者均获得随访,随访时间(28.64±4.01)个月(范围24~36个月)。2例患者术后出现局部皮下脂肪液化,经换药后痊愈;2例出现肌间静脉血栓形成,经抗凝治疗后血栓溶解。所有伤口均一期愈合。膝关节活动度由术前63.18°±17.07°提高到末次随访时的104.55°±16.80°,差异有统计学意义(t=14.041,P<0.001);KSS评分由(38.00±6.78)分提高到(80.91±5.65)分,差异有统计学意义(t=16.472,P<0.001)。UCLA活动能力评分由(3.18±1.17)分提高到(6.73±1.35)分,差异有统计学意义(t=9.694,P<0.001);VAS评分由(6.09±0.94)分降低到(2.32±0.64)分,差异有统计学意义(t=16.600,P<0.001)。末次随访时无一例发生髌骨脱位或半脱位、膝关节伸膝装置撕裂或断裂,以及假体周围感染和松动。结论全膝关节置换治疗骨关节炎合并固定性髌骨脱位可获得满意的早期临床效果,术中采用内侧滑膜瓣转位可有效修复外侧关节囊。Objective To systematically investigate the short-term efficacy of total knee arthroplasty in the treatment of osteoarthritis coupled with fixed patellar dislocation.Methods A retrospective analysis was conducted on a cohort of 11 patients diagnosed with knee osteoarthritis and fixed patellar dislocation who underwent total knee arthroplasty at Panzhihua Central Hospital from January 2018 to October 2021.The cohort comprised 4 males and 7 females,aged 63.45±4.76 years(range,56-70 years),all of whom underwent unilateral surgery.There were 5 left and 6 right knees,with a body mass index of 23.20±2.02 kg/m^(2)(range,20.8-27.6 kg/m^(2))and a disease course of 12.63±4.81 years.According to the American Society of Anesthesiologists classification,9 cases were categorized as grade II,and 2 cases as grade III.Recovery of patellar trajectory during total knee arthroplasty,using medial synovial flap transposition to repair lateral joint capsule.Preoperative and postoperative assessments included knee joint range of motion,Knee Society score(KSS),University of California Los Angeles(UCLA)score,and visual analogue scale(VAS).Results All 11 patients were followed up for a period of 28.64±4.01 months(range,24-36 months).Two patients exhibited subcutaneous fat liquefaction locally after surgery,which resolved following dressing changes.All wounds achieved primary healing.Two of them developed intramuscular vein thrombosis after surgery and were cured after anticoagulant treatment.The range of motion of the knee joint increased from 63.18°±17.07°before surgery to 104.55°±16.80°at the last follow-up,with a statistically significant difference(t=14.041,P<0.001).The KSS score increased from 38.00±6.78 points to 80.91±5.65 points,with a statistically significant difference(t=16.472,P<0.001).The UCLA score increased from 3.18±1.17 to 6.73±1.35,with a statistically significant difference(t=9.694,P<0.001).The VAS decreased from 6.09±0.94 points to 2.32±0.64 points,with a statistically significant difference(t=16.600,P<0

关 键 词：关节成形术 置换 膝 骨关节炎 膝 髌骨脱位 

分 类 号：R687.4[医药卫生—骨科学]