摘要
目的探讨人工全膝关节置换术(total knee arthroplasty,TKA)中髌骨置换与否对疗效的影响。方法将2013年3月—2015年8月收治且符合选择标准的30例(60膝)骨关节炎患者纳入研究。男24例,女6例;年龄37～65岁,平均57.2岁。体质量指数19.5～40.3 kg/m^2,平均28.2 kg/m^2。Kellgren-Lawrence分级:Ⅲ级8例,Ⅳ级22例。患者均行双膝TKA,随机选取一侧行髌骨置换(置换侧),另一侧不置换髌骨(未置换侧)。记录双侧术中出血量及手术时间。随访期间行膝关节学会评分系统(KSS)评分,参照人工关节被遗忘指数(FJS)评分计算遗忘率,观察膝前痛、膝关节束缚感、捻发音或握雪感、髌前弹响、髌腱无力发生情况;患者自评上下楼、屈曲负重、下蹲起立、盘腿、下跪、伸膝困难程度以及自我感觉评价;影像学检查观察假体位置。结果置换侧手术时间为(126±14)min,未置换侧为(112±11)min,比较差异有统计学意义(t=5.103,P=0.030);术中失血量两侧比较差异无统计学意义(t=3.431,P=0.800)。患者均获随访,随访时间2～4年,平均2.6年。术前及术后6周、6个月、2年时双侧KSS临床及功能评分比较,术前及术后6周双侧膝前痛疼痛视觉模拟评分(VAS)比较,术后6周、6个月、2年时双侧膝关节捻发音或握雪感、束缚感、膝前弹响、髌腱无力发生率比较,患者自评双侧上下楼、屈曲负重、下蹲起立、盘腿、下跪、伸膝困难率比较,以及术后2年时双侧FJS评分遗忘率比较,差异均无统计学意义(P>0.05);术后6个月及2年置换侧VAS评分显著低于未置换侧(Z=–1.997,P=0.046;Z=–2.197,P=0.028)。术后6周患者自我感觉评价分级髌骨置换侧好于未置换侧(x^2=4.271,P=0.039);术后6个月及2年两侧比较差异无统计学意义(P>0.05)。影像学检查显示,随访期间均无假体松动发生。结论 TKA术中行髌骨置换后患者总体感觉优于未置换。
Objective To investigate the effectiveness of total knee arthroplasty （TKA） with or without patellar resurfacing. Methods Between March 2013 and August 2015, 30 patients （60 knees） with osteoarthritis who met the inclusion criteria were recruited in the study. Of 30 cases, 24 were male and 6 were female with an average age of 57.2 years （range, 37-65 years）. The body mass index ranged from 19.5 to 40.3 kg/m2 （mean, 28.2 kg/m2）. According to Kellgren- Lawrence grading, there were 8 cases at grand Ⅲ and 22 cases at grand IV. All patients underwent primary bilateral TKA. The patellar resurfacing was done at the unilateral knee randomly （resurfacing side）; the opposite treatment was done at the other side （non-resurfacing side）. The indexes of 2 groups were recorded and compared, including the intraope- rative blood loss, operation time, knee society score （KSS）, ＂Forgotten Joint＂ scale （FJS）, anterior knee pain, anterior patellar spirant, knee constraint feeling, anterior patellar clunk, muscle power of knee extension, and ability of up and down stairs, weight-bearing flexion, squatting down, cross-legged, knee down, knee extension, and patient satisfaction. Radiographic examination was used to analyze the prosthesis position. Results The operation time were （126± 14） minutes and （112±11） minutes in resurfacing side and non-resurfacing side, respectively, showing significant difference between two sides （t=5.103, P=0.030）; and there was no significant difference in intraoperative blood loss between two sides （t=3.431, P=0.800）. All patients were followed up 2-4 years （mean, 2.6 years）. There was no significant difference （P〉0.05） between two sides in KSS clinical and functional scores at preoperation and 6 weeks, 6 months, and 2 years after operation; in visual analogue scale （VAS） score of anterior knee pain at preoperation and 6 weeks after operation; in incidences of anterior patellar spirant, knee constraint feeling, anterior patellar clunk, and muscle power of knee extension at 6 weeks, 6 months, and 2 years after operation; in incidences of disability of up and down stairs, weight-bearing flexion, squatting down, cross-legged, knee down, and knee extension at 6 weeks, 6 months, and 2 years after operation; in ratio of FJS score at 2 years after operation. The VAS scores at 6 months and 2 years after operation in resurfacing group were significantly lower than those in non-resurfacing group （Z=-1.997, P=0.046; Z=-2.197, P=0.028）. Patient satisfaction of resurfacing side was superior to the non-resurfacing side at 6 weeks after operation （X2=4.271, P=0.039）. Radiographic examination showed no prosthesis loosing occurred. Conclusion The effectiveness of TKA with patellar resurfacing is better than that with non-resurfacing in patients satisfaction.
作者
贾承奇
倪明
付君
李昕
李想
柴伟
陈继营
JIA Chengqi, NI Ming, FU Jun, LI Xin, LI Xiang, CHAI Wei, CHEN Jiying(Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.Chin)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2018年第4期394-399,共6页
Chinese Journal of Reparative and Reconstructive Surgery
基金
国家高技术研究发展计划(863)资助项目(2015AA033500)~~
