髌股关节置换术治疗膝关节髌股骨关节炎的中短期疗效观察
빈고관절치환술치료슬관절빈고골관절염적중단기료효관찰
Treatment of patellofemoral osteoarthritis with patello-femoral joint arthroplasty
  • 万方数据
    中华外科杂志 중화외과잡지
    CHINESE JOURNAL OF SURGERY
    2014年 5期 361-365 ,共5页

    张启栋%郭万首%刘朝晖%程立明%岳德波%王卫国%张念非%史振才

    장계동%곽만수%류조휘%정립명%악덕파%왕위국%장념비%사진재

    关节成形术,置换,膝%骨关节炎,膝%髌骨%四头肌 關節成形術,置換,膝%骨關節炎,膝%髕骨%四頭肌
    관절성형술,치환,슬%골관절염,슬%빈골%사두기
    Arthroplasty,replacement,knee%Osteoarthritis,knee%Patella%Quadriceps muscle
    目的 探讨分析髌股关节置换术治疗膝关节髌股骨关节炎的中短期疗效、手术技术及围手术期处理.方法 回顾性分析2010年1月至2012年6月收治的17例24膝髌股关节置换患者资料.其中男性2例4膝,女性15例20膝;年龄52 ～ 77岁,平均(64±9)岁;体重指数(BMI)18.0 ～30.1 kg/m2,平均(24±3)kg/m2.术后3、6个月、1年进行随访,此后每年随访1次.对患者满意度、膝关节疼痛视觉模拟量表(VAS)评分、关节活动度、膝关节美国纽约特种外科医院评分(HSS评分)、Feller髌骨评分、股四头肌肌力等进行评估分析,分析髌股关节置换临床效果、遇到的问题及应对方法.术前、术后的均值比较采用配对样本t检验,随访不同时间点的均值比较采用单组重复测量数据的方差分析.结果 术后随访18 ～47个月,平均(29±10)个月,无返修,无感染、深静脉血栓、假体脱位等.患者1年内满意度75.0％,末次随访满意度87.5％.HSS评分由术前(61±11)分增至(90±6)分(t=12.24,P=0.000).VAS评分由术前的(6.7±1.0)分降至(2.4±1.0)分(t=15.84,P=0.000).末次随访的膝关节活动度平均达126°±7°(t=3.25,P=0.003).Feller髌骨评分术前(18.0±3.2)分,术后3、6个月、1、2年、末次随访分别为(18.5±4.5)、(19.7±3.4)、(24.0±3.8)、(26.0±3.3)、(26.6±2.5)分;股四头肌肌力术前为(3.9±0.5)级,术后3、6个月、1、2年、末次随访分别为(3.7±0.5)、(3.9±0.5)、(4.2±0.5)、(4.3±0.5)、(4.3±0.5)级.单组重复测量数据的方差分析结果显示Feller髌骨评分(F =38.97,P=0.000)及股四头肌肌力(F=6.89,P=0.000)变化差异有统计学意义,但二者术后3、6个月分数较低,与术前相比差异无统计学意义(P＞0.05);二者在术后1、2年及末次随访的结果与术前、术后6个月相比有明显提高,差异有统计学意义(t=5.65 ～10.65和t=2.18 ～2.73,均P＜0.05).术后3膝疼痛不缓解,股四头肌肌力均不超4级.结论 髌股关节置换术治疗膝关节髌股间室骨关节炎中短期疗效满意,但是需要加强围手术期股四头肌肌力康复锻炼.
    목적 탐토분석빈고관절치환술치료슬관절빈고골관절염적중단기료효、수술기술급위수술기처리.방법 회고성분석2010년1월지2012년6월수치적17례24슬빈고관절치환환자자료.기중남성2례4슬,녀성15례20슬;년령52 ～ 77세,평균(64±9)세;체중지수(BMI)18.0 ～30.1 kg/m2,평균(24±3)kg/m2.술후3、6개월、1년진행수방,차후매년수방1차.대환자만의도、슬관절동통시각모의량표(VAS)평분、관절활동도、슬관절미국뉴약특충외과의원평분(HSS평분)、Feller빈골평분、고사두기기력등진행평고분석,분석빈고관절치환림상효과、우도적문제급응대방법.술전、술후적균치비교채용배대양본t검험,수방불동시간점적균치비교채용단조중복측량수거적방차분석.결과 술후수방18 ～47개월,평균(29±10)개월,무반수,무감염、심정맥혈전、가체탈위등.환자1년내만의도75.0％,말차수방만의도87.5％.HSS평분유술전(61±11)분증지(90±6)분(t=12.24,P=0.000).VAS평분유술전적(6.7±1.0)분강지(2.4±1.0)분(t=15.84,P=0.000).말차수방적슬관절활동도평균체126°±7°(t=3.25,P=0.003).Feller빈골평분술전(18.0±3.2)분,술후3、6개월、1、2년、말차수방분별위(18.5±4.5)、(19.7±3.4)、(24.0±3.8)、(26.0±3.3)、(26.6±2.5)분;고사두기기력술전위(3.9±0.5)급,술후3、6개월、1、2년、말차수방분별위(3.7±0.5)、(3.9±0.5)、(4.2±0.5)、(4.3±0.5)、(4.3±0.5)급.단조중복측량수거적방차분석결과현시Feller빈골평분(F =38.97,P=0.000)급고사두기기력(F=6.89,P=0.000)변화차이유통계학의의,단이자술후3、6개월분수교저,여술전상비차이무통계학의의(P＞0.05);이자재술후1、2년급말차수방적결과여술전、술후6개월상비유명현제고,차이유통계학의의(t=5.65 ～10.65화t=2.18 ～2.73,균P＜0.05).술후3슬동통불완해,고사두기기력균불초4급.결론 빈고관절치환술치료슬관절빈고간실골관절염중단기료효만의,단시수요가강위수술기고사두기기력강복단련.
    Objective To study the outcome and surgical technique of patello-femoral joint arthroplasty (PFJ) for osteoarthritis of the knee.Methods From January 2010 to June 2012,17 patients (24 knees) with patello-femoral compartmental osteoarthritis treated by PFJ were reviewed retrospectively.There were 2 male patients(4 knees) and 15 female patients(15 knees),with an average age of (64 ± 9) years (52-77 years).The mean body mass index was (24 ± 3) kg/rn2 (18.0-30.1 kg/m2).Patients were asked to return for follow-up examinations at 3,6 months and at every year after PFJ.The range of motion (ROM),visual analogue scale (VAS),Hospital for Special Surgery score (HSS score),Feller patella score,quadriceps muscle strength were evaluated before and after PFJ.The paired sample t-test and one-way analysis of variance (ANOVA) with replicate measures were used to determine whether there were statistically significant differences between the mean data.Results All of the patients were followed up for 18-47 months,with a mean time of (29 ± 10) months,75.0％ patients were satisfied with the outcome of this surgical procedure 1 year postoperative,and 87.5％ were satisfied 2 years postoperative.HSS score was increased from 61 ± 11 to 90 ±6 at the final follow-up(t =12.24,P=0.000).VAS score was reduced from 6.7 ± 1.0 to 2.4 ± 1.0(t =15.84,P =0.000).The mean post-operative ROM of the knees was 126° ±7° (t =3.25,P =0.003).Feller patella scores were 18.0 ± 3.2 before operation,and 18.5 ± 4.5,19.7 ± 3.4,24.0 ±3.8,26.0 ±3.3,26.6 ±2.5 at 3,6,12,24 months after operation,final follow-up,respectively.Quadriceps muscle strength were 3.9 ± 0.5 before operation,and 3.7 ± 0.5,3.9 ± 0.5,4.2 ± 0.5,4.3 ± 0.5,4.3 ± 0.5 at 3,6,12,24 months after operation,final follow-up,respectively.Repeated measures ANOVA found significant time effects for Feller patella scores(F =38.97,P =0.000)and quadriceps muscle (F =6.89,P =0.000).Feller patella scores and quadriceps muscle strength were low at 3,6 months after operation,with no significant differences compared with preoperation data(P ＞ 0.05).The improvements of Feller patella scores and quadriceps muscle strength after 6 months were of significant difference compared with preoperation and postoperative 6 months data(t =5.65-10.65 and t =2.18-2.73,P ＜ 0.05).Three knee reported continuing pains with quadriceps muscle strength less than 4 level.Conclusions PFJ is an effective method for patello-femoral compartmental osteoarthritis with less trauma.The early term outcome of PFJ is encouraging.Quadriceps muscle strength should be enhanced.
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