CAJ | 학술논문

目的：探讨髌骨置换针对严重髌股关节炎在膝关节置换术中的应用及临床疗效。方法：2004年2月-2010年11月间行膝关节表面置换的126例（149例膝关节）。术前查X线（负重侧位、45°Rosenberg相、Merchant轴位相），对髌股关节炎分级并测量髌骨厚度和髌股间隙，从而预测出髌骨假体厚度，使重建后的髌股间隙不大于原间隙。均采用统一膝关节假体（smith&nephew ），由同一组医生完成。术中行髌骨截骨后假体置换，并在置换前后测量髌骨的运动轨迹。术后随访。膝关节评分（HSS评分），髌骨评分（Feller评分），结果应用SPSS13．0软件行统计学分析。结果：术中股骨和胫骨假体试模安装完成后，行髌骨截骨安装假体，140例均髌骨轨迹良好，可以达到“no thumb test”，9例采用了外侧支持带松解等操作，后髌骨轨迹良好。术后126患者均获得随访12个月，膝关节屈伸活动度平均110.5°（90°～125°），出现19髌前疼痛口服非甾体类药物逐渐缓解，无1例出现髌骨脱位、半脱位、髌骨坏死、髌骨坏死、髌骨骨折及皮肤坏死等。结论：对于严重的髌股关节炎行髌骨置换后可以更好的重建髌股关节，改善关节屈伸功能，减少髌骨的相关并发症。
목적：탐토빈골치환침대엄중빈고관절염재슬관절치환술중적응용급림상료효。방법：2004년2월-2010년11월간행슬관절표면치환적126례（149례슬관절）。술전사X선（부중측위、45°Rosenberg상、Merchant축위상），대빈고관절염분급병측량빈골후도화빈고간극，종이예측출빈골가체후도，사중건후적빈고간극불대우원간극。균채용통일슬관절가체（smith&nephew ），유동일조의생완성。술중행빈골절골후가체치환，병재치환전후측량빈골적운동궤적。술후수방。슬관절평분（HSS평분），빈골평분（Feller평분），결과응용SPSS13．0연건행통계학분석。결과：술중고골화경골가체시모안장완성후，행빈골절골안장가체，140례균빈골궤적량호，가이체도“no thumb test”，9례채용료외측지지대송해등조작，후빈골궤적량호。술후126환자균획득수방12개월，슬관절굴신활동도평균110.5°（90°～125°），출현19빈전동통구복비치체류약물축점완해，무1례출현빈골탈위、반탈위、빈골배사、빈골배사、빈골골절급피부배사등。결론：대우엄중적빈고관절염행빈골치환후가이경호적중건빈고관절，개선관절굴신공능，감소빈골적상관병발증。
Objective :To discuss serious patellofemoral arthritis in patella replacement in the application and clinical curative effect of knee arthroplasty .Methods :In February 2004 to November 2010 ,126 cases of knee joint surface re-placement (149 cases of knee joints ) .Preoperative X-ray check (lateral load-bearing ,45°Rosenberg phase ,phase break shaft) ,classification and measurement of patellofemoral arthritis patellar thickness and patellofemoral gap ,so as to predict the thickness of the patellar prosthesis ,the reconstruction of patellofemoral clearance is not more than the origi-nal clearance .After intraoperative osteotomy patella prosthesis and trajectory measurements before and after the re-placement of the patella .Postoperative follow-up .Knee Score (HSS score) ,patellar score (Feller score) ,the results were analyzed by SPSS13 .0 software line .Results:After intraoperative femoral and tibial prosthesis tryout installation is complete ,install the line patella prosthesis osteotomy ,140 cases were good patellar tracking can be achieved“no thumb test” ,9 cases with a lateral release and other operations ,the patella track is good .126 postoperative patients were followed up for 12 months ,an average of 110 .5° knee flexion mobility (90° to 125°) ,appeared before the 19th pa-tellar oral nonsteroidal drugs gradually pain relief ,and none of the patellar dislocation and subluxation ,patellar necro-sis ,patellar fracture and skin necrosis .Conclusion:For serious patellofemoral arthritis after patellar replacement can better reconstruction of patellofemoral joint ,improve the function of joint flexion and extension ,reduce the related com-plications of patella .