摘要
背景:全膝关节表面置换后有关髌股关节问题的并发症高达39%,而造成置换后髌股关节并发症的原因很多,其中低位髌骨是引起髌股关节并发症的原因之一,但是常被临床医生忽视。目的:分析初次全膝关节表面置换后导致髌股关节并发症的原因之一髌骨低位的发生机制。方法:回顾性分析2003-07/2009-01河北医科大学第三医院关节骨科行初次全膝关节表面置换患者78例85膝临床资料。按照HSS膝关节评分将病例分成两组,高分组和低分组。将两组置换前后膝关节X射线片对照,应用Insall-salvati法测量髌骨的高度,并利用Hofmann方法测量关节线的位置变化。运用Logistic回归分析方法分析低位髌骨与Insall-salvati指数及关节线变化的相关性。结果与结论:高分组59膝未发生低位髌骨;低分组26膝中23膝发生不同程度的髌骨低位,其中6膝Insall-salvati指数为1.1±0.1,17膝关节线上移(7.0±2.3)mm。Logistic回归分析结果显示低位髌骨发生与Insall-salvati指数和关节线的上移有一定关系。提示初次全膝表面置换后髌骨下移的发生是由于胫骨聚已烯垫的厚度大于截骨的厚度即关节线上移和髌韧带的挛缩引起的。因此在初次全膝关节表面置换中要最大程度恢复原有的膝关节线位置,并加强早期的膝关节功能锻炼,以尽快恢复膝关节的活动度,防止髌韧带的挛缩。
BACKGROUND：The rate of complications of patellofemoral joint following total knee arthroplasty （TKA） is about 39%. There are many causes for these complications,and patellar baja,one of important causes for patellofemoral joint problem has been frequently ignored. OBJECTIVE：To investigate the mechanism of patella baja following primary TKA. METHODS：Clinical data of 78 cases （85 knees） undergoing primary TKA knees in Department of Orthopedics,Third Hospital of Hebei Medical University between July 2003 and January 2009,were retrospectively analyzed. According to HSS scores,they were assigned to high scores and low scores groups. X-ray of two groups before and after TKA was compared. Insall-salvati index was used to measure the height of patella and Hofmann＇s procedure was used to measure the variation of the joint line. Logistic regression was performed to analyze the correlation of patellar baja with the insall-salvati index and the proximally transferring joint line. RESULTS AND CONCLUSION：The 59 knees in high scores group did not suffered patellar baja; 23 of 26 knees in low scores group occurred patellar baja,and the insall-salvati index was 1.1±0.1 in 6 knees and joint line elevated （7±2.3） mm in 17 knees. Patella baja were correlated with insall-salvati index and elevation of joint line through the logistic regression. The patella baja was caused by the tibial polyethylene thicker than the tibial resecting bone,i.e. elevated proximally transferring joint line and contracted patellar ligament. Therefore,we should maintain the original joint line maximally during TKA and enhance knee rehabilitation as soon as possible to restrain patellar ligament contracture.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2010年第52期9693-9696,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
