人工全膝關節置換術中髕骨未置換對療效的影響_《中國修復重建外科雜志》

作者：

阿吉木克熱木 ¹ , 買買提艾力哈斯木 ² , 單平聯 ¹ , 阿不都艾拉 ¹

1 喀什地區第一人民醫院骨一科（新疆喀什，844000）;;
2 新疆醫科大學附屬腫瘤醫院骨科;

關鍵詞：

人工全膝關節置換術髕骨置換骨關節炎

DOI：

10.7507/1002-1892.20130254

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目的探討采用旋轉活動平臺假體行人工全膝關節置換術（total knee arthroplasty，TKA）中髕骨未置換對術后療效的影響。方法回顧分析2008 年 4 月－2011年 4月采用旋轉活動平臺假體行TKA且髕骨未置換的 163 例膝關節退變性骨關節炎患者臨床資料。男65例，女98例；年齡54～78歲，平均63歲。術中髕骨軟骨退變根據Outerbridge分級標準：Ⅰ級22例，Ⅱ級38例，Ⅲ級64例，Ⅳ級39例。各級患者間性別、年齡及側別比較，差異均無統計學意義（P gt; 0.05）。記錄術中止血帶使用時間以及相關并發癥發生情況，膝關節功能采用美國膝關節學會評分系統（KSS）和髕骨評分（PS）評定，患者滿意度以及膝前痛采用疼痛視覺模擬評分（VAS）評估；常規攝X線片，觀察假體及髕骨位置。結果術中止血帶使用時間為90～150 min，平均125 min；術后切口均Ⅰ期愈合，無早期相關并發癥發生。患者均獲隨訪，隨訪時間2～5年，平均3.6年。術后6個月及末次隨訪時，患者KSS及PS評分均較術前顯著提高（P lt; 0.05）；術后6個月及末次隨訪時比較，差異無統計學意義（P gt; 0.05）。不同髕骨軟骨退變等級患者間，術前KSS及PS評分比較差異有統計學意義（P lt; 0.05），但末次隨訪時比較差異均無統計學意義（P gt; 0.05）。末次隨訪時，7例患者出現持續膝前痛，根據VAS評定標準評定為輕度疼痛5例，中度2例；患者滿意度評價：非常滿意90例，滿意66例，不確定5例，不滿意2例。不同髕骨軟骨退變等級患者間滿意度及膝前痛比較，差異均無統計學意義（P gt; 0.05）。結論采用旋轉活動平臺假體行TKA時髕骨未置換對術后療效無明顯影響。

引用本文： 阿吉木克熱木,買買提艾力哈斯木,單平聯,阿不都艾拉. 人工全膝關節置換術中髕骨未置換對療效的影響. 中國修復重建外科雜志, 2013, 27(10): 1157-1161. doi: 10.7507/1002-1892.20130254 復制

1.	Swan JD, Stoney JD, Lim K, et al. The need for patellar resurfacing in total knee arthroplasty: a literature review. ANZ J Surg, 2010, 80(4): 223-233.
2.	Patel K, Raut V. Patella in total knee arthroplasty: to resurface or not to—a cohort study of staged bilateral total knee arthroplasty. Int Orthop, 2011, 35(3): 349-353.
3.	Seijas R, Orduna JM, Castro MC, et al. Fracture of the unresurfaced patella after total knee arthroplasty: a report of two cases. J Orthop Surg (Hong Kong), 2009, 17(2): 251-254.
4.	Brick GW, Scott RD. The patellofemoral component of total knee arthroplasty. Clin Orthop Relat Res, 1988, (231): 163-178.
5.	Picetti GD 3rd, McGann WA, Welch RB. The patellofemoral joint after total knee arthroplasty without patellar resurfacing. J Bone Joint Surg (Am), 1990, 72(9): 1379-1382.
6.	Outerbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg (Br), 1961, 43-B: 752-757.
7.	曾金才, 孫俊英, 楊立文, 等. 關節內置管局部浸潤鎮痛在全膝關節置換術的應用. 中國矯形外科雜志, 2009, 17(21): 1609-1612.
8.	Insall JN, Dorr LD, Scott RD, et al. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res, 1989, (248): 13-14.
9.	Feller JA, Bartlett RJ, Lang DM. Patellar resurfacing versus retention in total knee arthroplasty. J Bone Joint Surg (Br), 1996, 78(2): 226-228.
10.	Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res, 1989, (248): 9-12.
11.	Gomes LS, Bechtold JE, Gustilo RB. Patellar prosthesis positioning in total knee arthroplasty. A roentgenographic study. Clin Orthop Relat Res, 1988, (236): 72-81.
12.	Altay MA, Ertürk C, Altay N, et al. Patellar denervation in total knee arthroplasty without patellar resurfacing: a prospective, randomized controlled study. Orthop Traumatol Surg Res, 2012, 98(4): 421-425.
13.	Rodríguez-Merchán EC, Gómez-Cardero P. The outerbridge classification predicts the need for patellar resurfacing in TKA. Clin Orthop Relat Res, 2010, 468(5): 1254-1257.
14.	Whiteside LA, Nakamura T. Effect of femoral component design on unresurfaced patellas in knee arthroplasty. Clin Orthop Relat Res, 2003, (410): 189-198.
15.	查國春, 孫俊英, 田家祥, 等. 髕骨軟骨退變分級對保留髕骨型全膝關節置換術療效的影響. 中華骨科雜志, 2013, 33(3): 226-233.
16.	Breugem SJ, Sierevelt IN, Schafroth MU, et al. Less anterior knee pain with a mobile-bearing prosthesis compared with a fixed-bearing prosthesis. Clin Orthop Relat Res, 2008, 466(8): 1959-1965.
17.	Peretz JI, Driftmier KR, Cerynik DL, et al. Does lateral release change patellofemoral forces and pressures?: a pilot study. Clin Orthop Relat Res, 2012, 470(3): 903-909.
18.	van Jonbergen HP, Scholtes VA, van Kampen A, et al. A randomised, controlled trial of circumpatellar electrocautery in total knee replacement without patellar resurfacing. J Bone Joint Surg (Br), 2011, 93(8): 1054-1059.
19.	衛小春, 王小虎, 張志強, 等. 髕骨軟骨破壞程度對保留髕骨的全膝關節置換術療效的影響. 中華骨科雜志, 2011, 31(2): 126-130.

1. Swan JD, Stoney JD, Lim K, et al. The need for patellar resurfacing in total knee arthroplasty: a literature review. ANZ J Surg, 2010, 80(4): 223-233.
2. Patel K, Raut V. Patella in total knee arthroplasty: to resurface or not to—a cohort study of staged bilateral total knee arthroplasty. Int Orthop, 2011, 35(3): 349-353.
3. Seijas R, Orduna JM, Castro MC, et al. Fracture of the unresurfaced patella after total knee arthroplasty: a report of two cases. J Orthop Surg (Hong Kong), 2009, 17(2): 251-254.
4. Brick GW, Scott RD. The patellofemoral component of total knee arthroplasty. Clin Orthop Relat Res, 1988, (231): 163-178.
5. Picetti GD 3rd, McGann WA, Welch RB. The patellofemoral joint after total knee arthroplasty without patellar resurfacing. J Bone Joint Surg (Am), 1990, 72(9): 1379-1382.
6. Outerbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg (Br), 1961, 43-B: 752-757.
7. 曾金才, 孫俊英, 楊立文, 等. 關節內置管局部浸潤鎮痛在全膝關節置換術的應用. 中國矯形外科雜志, 2009, 17(21): 1609-1612.
8. Insall JN, Dorr LD, Scott RD, et al. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res, 1989, (248): 13-14.
9. Feller JA, Bartlett RJ, Lang DM. Patellar resurfacing versus retention in total knee arthroplasty. J Bone Joint Surg (Br), 1996, 78(2): 226-228.
10. Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res, 1989, (248): 9-12.
11. Gomes LS, Bechtold JE, Gustilo RB. Patellar prosthesis positioning in total knee arthroplasty. A roentgenographic study. Clin Orthop Relat Res, 1988, (236): 72-81.
12. Altay MA, Ertürk C, Altay N, et al. Patellar denervation in total knee arthroplasty without patellar resurfacing: a prospective, randomized controlled study. Orthop Traumatol Surg Res, 2012, 98(4): 421-425.
13. Rodríguez-Merchán EC, Gómez-Cardero P. The outerbridge classification predicts the need for patellar resurfacing in TKA. Clin Orthop Relat Res, 2010, 468(5): 1254-1257.
14. Whiteside LA, Nakamura T. Effect of femoral component design on unresurfaced patellas in knee arthroplasty. Clin Orthop Relat Res, 2003, (410): 189-198.
15. 查國春, 孫俊英, 田家祥, 等. 髕骨軟骨退變分級對保留髕骨型全膝關節置換術療效的影響. 中華骨科雜志, 2013, 33(3): 226-233.
16. Breugem SJ, Sierevelt IN, Schafroth MU, et al. Less anterior knee pain with a mobile-bearing prosthesis compared with a fixed-bearing prosthesis. Clin Orthop Relat Res, 2008, 466(8): 1959-1965.
17. Peretz JI, Driftmier KR, Cerynik DL, et al. Does lateral release change patellofemoral forces and pressures?: a pilot study. Clin Orthop Relat Res, 2012, 470(3): 903-909.
18. van Jonbergen HP, Scholtes VA, van Kampen A, et al. A randomised, controlled trial of circumpatellar electrocautery in total knee replacement without patellar resurfacing. J Bone Joint Surg (Br), 2011, 93(8): 1054-1059.
19. 衛小春, 王小虎, 張志強, 等. 髕骨軟骨破壞程度對保留髕骨的全膝關節置換術療效的影響. 中華骨科雜志, 2011, 31(2): 126-130.

《中國修復重建外科雜志》

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《中國修復重建外科雜志》

人工全膝關節置換術中髕骨未置換對療效的影響

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