外侧支持带松解对人工全膝关节置换术后膝前痛的影响

发布时间：2018-04-04 17:39

  本文选题：人工全膝关节置换术　切入点：外侧支持带松解　出处：《中国修复重建外科杂志》2017年05期

【摘要】：目的探讨髌骨保留型人工全膝关节置换术(total knee arthroplasty,TKA)中外侧支持带松解与否对临床疗效的影响。方法采用前瞻性随机对照研究,将2012年10月—2014年10月收治并符合选择标准的132例单侧膝关节退变性关节炎患者随机分为2组(n=66),试验组TKA术中行髌骨外侧支持带松解,对照组术中不松解外侧支持带。试验组2例患者失访,对照组4例患者术中发现需松解外侧支持带,排除研究;试验组和对照组最终纳入64例和62例。两组患者性别、年龄、体质量指数、侧别、病程及术前髌骨形态、髌股关节炎分级、髌骨软骨退变等级、髌骨位置不良、髌骨轨迹不良、髌骨评分、膝关节学会评分系统(KSS)等一般资料比较,差异均无统计学意义(P0.05),具有可比性。记录两组患者手术时间、术后引流量、住院时间、术后并发症及患者主观满意度;术后膝前痛采用疼痛视觉模拟评分(VAS)评估,采用KSS评分、髌骨评分评价膝关节功能;在X线片上测量股骨角、胫骨角、股骨屈曲角及胫骨后倾角评价假体力线;观察术后髌骨轨迹及髌骨位置,以及有无骨溶解、假体松动、髌骨骨折和髌骨坏死等并发症发生。结果术后两组患者均随访24个月。两组患者手术时间、术后引流量、住院时间、患者主观满意度比较差异均无统计学意义(P0.05);试验组术后膝前痛发生情况优于对照组(P=0.033)。两组术后24个月KSS评分及髌骨评分均较术前显著改善(P0.05);术后24个月时两组间比较差异无统计学意义(P0.05)。术后发生血肿3例(试验组2例、对照组1例),轻度切口裂开4例(各2例),切口皮缘坏死1例(试验组),切口表浅感染2例(各1例),均经保守治疗痊愈;两组均未发生髌骨坏死、髌骨骨折、膝外侧痛等并发症;两组并发症发生率比较差异无统计学意义(P=0.392)。随访期间两组患者假体力线均满意,两组股骨角、胫骨角、股骨屈曲角及胫骨后倾角比较差异均无统计学意义(P0.05)。两组骨水泥-骨界面均无透光带及骨溶解。试验组和对照组分别有3例和5例发生髌骨轨迹不良,比较差异无统计学意义(P=0.488);但试验组髌骨位置不良发生率(18.8%)明显低于对照组(35.5%)(χ~2=0.173,P=0.034)。结论髌骨保留型TKA术中行外侧支持带松解能够降低术后膝前痛发生率,并且不增加术后并发症发生风险。
[Abstract]:Objective to investigate the patella retaining total knee arthroplasty (total knee, arthroplasty, TKA) of lateral retinacular release and the influence on clinical efficacy. Methods a prospective randomized controlled study, 132 cases were randomly divided into single knee joint degenerative arthritis patients from October 2012 to October 2014 and will meet the selection criteria for 2 group (n=66), TKA of experimental group in lateral retinaculum, control group were without release of the lateral retinaculum. The experimental group of 2 patients were lost to follow-up, 4 patients in control group were required to release of the lateral retinaculum, excluded studies; the test group and the control group included 64 cases and in 62 cases. Two groups of patients with gender, age, body mass index, side, duration and preoperative patellar morphology, patellofemoral osteoarthritis grading, patellar cartilage degeneration grade, patella bad location, patella maltracking, patellar score, Knee Society scoring system (KSS) etc. Comparison of general information, there were no significant differences (P0.05), comparable. Records of two groups of patients with operation time, postoperative drainage, hospitalization time, postoperative complications and patient satisfaction; postoperative anterior knee pain with visual analogue scale (VAS) assessed by KSS score, patellar score of knee joint function; measurement in X-ray femoral angle, tibial angle, femoral flexion angle and posterior tibial slope evaluation prosthesis force line; postoperative tracking of the patella and patella position, and there is no osteolysis, loosening, fracture of patella and patella occurred necrosis and other complications. Results two patients were followed up for 24 months. Two groups of patients with operation time, postoperative drainage, hospitalization time, satisfaction degree of patients showed no significant difference (P0.05); the experimental group postoperative incidence of anterior knee pain than the control group (P=0.033). The two groups 24 months after surgery, KSS score and evaluation of patella 鍒嗗潎杈冩湳鍓嶆樉钁楁敼鍠，

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