CAJ | 학술논문

目的探讨髌骨软骨退变Outerbridge分级对保留髌骨型全膝关节置换术疗效的影响.方法对2007年2月至2010年1月因膝关节退变性骨关节炎行保留髌骨型全膝关节置换术的151例进行回顾性分析.男65例,女86例；年龄56～82岁,平均(65±5.0)岁.随访时间2～5年,平均3.5年.术中对髌骨软骨退变分级的评定采用Outerbridge标准,统计末次随访时不同髌骨软骨退变分级患者的满意度及膝前痛发生情况,视觉模拟评分(visual analogue scale,VAS)＞3分判定为有膝前痛；比较不同髌骨软骨退变分级患者的美国膝关节学会评分(Knee Society Scale,KSS)及髌骨评分.结果 OuterbridgeⅠ级18例、Ⅱ级36例、Ⅲ级62例、Ⅳ级35例.膝前痛发生率4.0％(6/151),其中轻度疼痛4例、中度2例.无翻修病例,总体满意率96.7％(146/151).不同髌骨软骨退变分级患者的满意度(H=5.54,P=0.14)、膝前痛发生率(H=0.56,P=0.91)、KSS膝评分(F=1.95,P=0.12)、功能评分(F=2.11,P=0.10)及髌骨评分(F=1.35,P=0.26)的差异均无统计学意义.结论不同髌骨软骨退变分级患者行保留髌骨型全膝关节置换术后疗效无差异,对退变性骨关节炎患者行全膝关节置换术时无须置换髌骨.
목적 탐토빈골연골퇴변Outerbridge분급대보류빈골형전슬관절치환술료효적영향.방법 대2007년2월지2010년1월인슬관절퇴변성골관절염행보류빈골형전슬관절치환술적151례진행회고성분석.남65례,녀86례；년령56～82세,평균(65±5.0)세.수방시간2～5년,평균3.5년.술중대빈골연골퇴변분급적평정채용Outerbridge표준,통계말차수방시불동빈골연골퇴변분급환자적만의도급슬전통발생정황,시각모의평분(visual analogue scale,VAS)＞3분판정위유슬전통；비교불동빈골연골퇴변분급환자적미국슬관절학회평분(Knee Society Scale,KSS)급빈골평분.결과 OuterbridgeⅠ급18례、Ⅱ급36례、Ⅲ급62례、Ⅳ급35례.슬전통발생솔4.0％(6/151),기중경도동통4례、중도2례.무번수병례,총체만의솔96.7％(146/151).불동빈골연골퇴변분급환자적만의도(H=5.54,P=0.14)、슬전통발생솔(H=0.56,P=0.91)、KSS슬평분(F=1.95,P=0.12)、공능평분(F=2.11,P=0.10)급빈골평분(F=1.35,P=0.26)적차이균무통계학의의.결론 불동빈골연골퇴변분급환자행보류빈골형전슬관절치환술후료효무차이,대퇴변성골관절염환자행전슬관절치환술시무수치환빈골.
Objective To investigate the influence of cartilage degeneration grades of patellar on the clinical outcomes after total knee arthroplasty (TKA) without patellar resurfacing.Methods 151 patients performed TKA without patellar resurfacing from February 2007 to January 2010 were retrospective studied.There were 65 males and 86 females,with the mean age of 65±5.0 years (range,56-82 years).The mean duration of follow-up was 3.5 years (range,2-5 years).Intraoperatively,the cartilage degeneration was classified according to Outerbridge classification.At the final follow-up,the patients' satisfaction was evaluated,and the incidence of anterior knee pain was assessed using visual analogue scale (VAS).If VAS was more than 3 points,patient was defined suffered anterior knee pain.Compare KSS and patella score of patients with different grades of cartilage degeneration.Results The articular cartilage of the patella was graded according to Outerbridge:grade Ⅰ in 18 patients,grade Ⅱ in 36 patients,grade Ⅲ in 62 patients,and grade Ⅳ in 35 patients.At the final follow-up,the patients' satisfaction rate and the anterior knee pain rate was 96.7％ 046/151) and 4.0％ (6/151),respectively.In the patients with different grades of cartilage degeneration,the patient satisfaction rate (H=5.54,P=0.14),anterior knee pain rate (H=0.56,P=0.91),KSS (knee score:F=1.95,P=0.12； function score:F=2.11,P=0.10) and patella score (F=1.35,P=0.26) were not found to be significantly difference.Conclusion The differentiae grades of cartilage degeneration may not affect the clinical outcomes of TKA.TKA without patella resurfacing appears to be a reasonable option for degenerative osteoarthritis.