人工全膝关节置换术中髌骨未置换对疗效的影响_《中国修复重建外科杂志》

作者：

阿吉木克热木 ¹ , 买买提艾力哈斯木 ² , 单平联 ¹ , 阿不都艾拉 ¹

1 喀什地区第一人民医院骨一科（新疆喀什，844000）;;
2 新疆医科大学附属肿瘤医院骨科;

关键词：

人工全膝关节置换术髌骨置换骨关节炎

DOI：

10.7507/1002-1892.20130254

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的探讨采用旋转活动平台假体行人工全膝关节置换术（total knee arthroplasty，TKA）中髌骨未置换对术后疗效的影响。方法回顾分析2008 年 4 月－2011年 4月采用旋转活动平台假体行TKA且髌骨未置换的 163 例膝关节退变性骨关节炎患者临床资料。男65例，女98例；年龄54～78岁，平均63岁。术中髌骨软骨退变根据Outerbridge分级标准：Ⅰ级22例，Ⅱ级38例，Ⅲ级64例，Ⅳ级39例。各级患者间性别、年龄及侧别比较，差异均无统计学意义（P gt; 0.05）。记录术中止血带使用时间以及相关并发症发生情况，膝关节功能采用美国膝关节学会评分系统（KSS）和髌骨评分（PS）评定，患者满意度以及膝前痛采用疼痛视觉模拟评分（VAS）评估；常规摄X线片，观察假体及髌骨位置。结果术中止血带使用时间为90～150 min，平均125 min；术后切口均Ⅰ期愈合，无早期相关并发症发生。患者均获随访，随访时间2～5年，平均3.6年。术后6个月及末次随访时，患者KSS及PS评分均较术前显著提高（P lt; 0.05）；术后6个月及末次随访时比较，差异无统计学意义（P gt; 0.05）。不同髌骨软骨退变等级患者间，术前KSS及PS评分比较差异有统计学意义（P lt; 0.05），但末次随访时比较差异均无统计学意义（P gt; 0.05）。末次随访时，7例患者出现持续膝前痛，根据VAS评定标准评定为轻度疼痛5例，中度2例；患者满意度评价：非常满意90例，满意66例，不确定5例，不满意2例。不同髌骨软骨退变等级患者间满意度及膝前痛比较，差异均无统计学意义（P gt; 0.05）。结论采用旋转活动平台假体行TKA时髌骨未置换对术后疗效无明显影响。

引用本文： 阿吉木克热木,买买提艾力哈斯木,单平联,阿不都艾拉. 人工全膝关节置换术中髌骨未置换对疗效的影响. 中国修复重建外科杂志, 2013, 27(10): 1157-1161. doi: 10.7507/1002-1892.20130254 复制

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, 孙俊英, 杨立文, 等. 关节内置管局部浸润镇痛在全膝关节置换术的应用. 中国矫形外科杂志, 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.	查国春, 孙俊英, 田家祥, 等. 髌骨软骨退变分级对保留髌骨型全膝关节置换术疗效的影响. 中华骨科杂志, 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.	卫小春, 王小虎, 张志强, 等. 髌骨软骨破坏程度对保留髌骨的全膝关节置换术疗效的影响. 中华骨科杂志, 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, 孙俊英, 杨立文, 等. 关节内置管局部浸润镇痛在全膝关节置换术的应用. 中国矫形外科杂志, 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. 查国春, 孙俊英, 田家祥, 等. 髌骨软骨退变分级对保留髌骨型全膝关节置换术疗效的影响. 中华骨科杂志, 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. 卫小春, 王小虎, 张志强, 等. 髌骨软骨破坏程度对保留髌骨的全膝关节置换术疗效的影响. 中华骨科杂志, 2011, 31(2): 126-130.

《中国修复重建外科杂志》

人工全膝关节置换术中髌骨未置换对疗效的影响

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《中国修复重建外科杂志》

人工全膝关节置换术中髌骨未置换对疗效的影响

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