双膝关节置换术中髌骨置换与否的左右侧随机对照研究

发布时间：2018-04-14 15:02

本文选题：全膝关节置换术 + 髌骨置换　；参考：《北京大学学报(医学版)》2017年05期

【摘要】：目的:双膝关节置换术中随机选择一侧置换髌骨,对侧保留髌骨,对比研究髌骨置换与否对术后临床效果的影响。方法:共入选14例双膝骨关节炎患者,28个膝,均为女性,年龄为53~78岁,平均(66.9±7.8)岁,体重指数为(26.3±1.8)kg/m2。随机分组为拟行左侧或右侧髌骨置换和对侧髌骨保留,术后均获随访,随访时间为3~12个月。随访时记录患者手术前后双膝美国膝关节协会评分(American Knee Society score,KSS)、关节活动度(range of motion,ROM)、术后髌骨倾斜角(patellar tilt angle,PTA)、有无术后膝前痛及髌骨弹响、有无术后膝关节并发症等。结果:术后切口均一期愈合,无感染、松动、髌骨骨折等并发症发生。髌骨置换侧KSS评分由术前的(38.9±22.2)分提高至(92.4±6.7)分,术后较术前KSS增加值为(53.5±20.3)分;保留髌骨侧KSS评分由术前的(38.4±20.5)分提高至(92.1±4.2)分,术后较术前KSS增加为(53.7±21.4)分,两组间KSS评分的增加差异无统计学意义(P=0.98)。髌骨置换侧关节活动度由术前的95.4°±13.5°提高至120.4°±8.9°,术后ROM较术前增加为25.0°±14.5°;保留髌骨侧ROM由术前的92.9°±19.1°增加至120.4°±8.4°,术后较术前ROM增加为27.5°±19.4°,两组间ROM的增加差异也无统计学意义(P=0.70)。术后随访时,患者髌骨置换侧出现膝前痛共3膝(占21.4%),而保留髌骨侧膝前痛共出现2膝(占14.3%),两组间膝前痛的发生率比较差异无统计学意义(P=0.62)。术后髌骨置换侧出现髌骨弹响共3膝(占21.4%),保留髌骨侧3膝(占21.4%),组间比较差异无统计学意义。髌骨置换侧术后PTA为2.6°±2.6°,保留髌骨侧为3.6°±2.9°,两者间差异无统计学意义(P=0.36)。结论:全膝关节置换术中,对于髌骨关节面轻中度破坏的骨关节炎患者,髌骨置换较髌骨保留在术后膝前痛、髌骨弹响的发生率、术后关节功能改善及髌股轨迹等方面并无明显优势。
[Abstract]:Objective: to study the influence of patellar replacement or not on the clinical effect of double knee arthroplasty by randomly selecting one side patella replacement and contralateral patellar preservation.Methods: a total of 14 patients with osteoarthritis of both knees were enrolled, 28 knees were female, the age was 53 to 78 years old, the average age was 66.9 卤7.8 years old, and the body mass index was 26.3 卤1.8 kg / m ~ (2).Left or right patellar replacement and contralateral patella preservation were randomly divided into two groups. All patients were followed up for 3 ~ 12 months.The American Knee Society score before and after operation, the range of motion of the knee, the patellar tilt angle, the anterior knee pain and the patellar bounce, and the postoperative complications of knee joint were recorded.Results: all the postoperative incisions healed without infection, loosening, patellar fracture and other complications.The KSS score of the patellar replacement side increased from 38.9 卤22.2 to 92.4 卤6.7, and the increase of postoperative KSS was 53.5 卤20.3, while the KSS score of the patellar preserving side increased from 38.4 卤20.5 to 92.1 卤4.2), and the postoperative KSS increased to 53.7 卤21.4than that of the preoperative KSS.There was no significant difference in KSS score between the two groups (P < 0. 98).The range of joint motion in the patellar replacement side increased from 95.4 掳卤13.5 掳to 120.4 掳卤8.9 掳, and the postoperative ROM increased from 25.0 掳卤14.5 掳to 25.0 掳卤14.5 掳, while the patellar side ROM increased from 92.9 掳卤19.1 掳to 120.4 掳卤8.4 掳, and the postoperative ROM increased from 27.5 掳卤19.4 掳to 27.5 掳卤19.4 掳. There was no significant difference in ROM between the two groups.At postoperative follow-up, anterior knee pain was found in 3 knees (21.4%) in the patellar replacement side and 2 knees (14.3%) in the preserving patellar anterior knee pain. There was no significant difference in the incidence of anterior knee pain between the two groups.There were 3 knees (21. 4%) in the patellar replacement side and 3 knees (21. 4%) in the reserved patellar side. There was no significant difference between the two groups.The PTA was 2.6 掳卤2.6 掳in the patellar replacement side and 3.6 掳卤2.9 掳in the reserved patellar side. There was no significant difference between the two groups.Conclusion: in total knee arthroplasty, the incidence of patellar osteoarthritis with mild and moderate destruction of patellar articular surface is higher than that of patellar anterior knee pain and patellar bounce.There was no obvious advantage in the improvement of joint function and patellofemoral locus after operation.
【作者单位】：北京大学人民医院关节病诊疗研究中心;北京大学国际医院骨科;
【基金】：国家自然科学基金资助(81371925)~~
【分类号】：R687.4

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