中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2012年
11期
996-1000
,共5页
孙业青%朱裕昌%蔡新宇%蔡郑东
孫業青%硃裕昌%蔡新宇%蔡鄭東
손업청%주유창%채신우%채정동
膝损伤%关节成形术,置换,膝%髌骨
膝損傷%關節成形術,置換,膝%髕骨
슬손상%관절성형술,치환,슬%빈골
Knee injuries%Arthroplasty,replacement,knee%Patella
目的 比较全膝关节置换术(total knee arthroplasty,TKA)中保留髌骨下进行髌骨成形与髌骨置换的术后临床疗效,探讨膝关节置换中合适的髌骨处理方法.方法 回顾性分析2002年1月-2008年12月收治的共198例行TKA治疗的单纯骨关节炎患者,其中62例行髌骨置换术,136例行保留髌骨下髌骨成形术.术中对髌骨进行去除骨赘后进行成形,使之与原髌骨关节面比较相近.术后定期随访进行美国膝关节协会评分(KSS)、Bristol髌骨评分、患者满意度、膝关节活动度及分析术后膝前疼痛发生率,并复查X线片了解内置物情况.结果 共125例获得随访,其中置换组43例,成形组82例,随访时间36～80个月,平均51个月.两组患者术后较术前各项评分明显提高.术后1年随访时两组患者术后膝关节活动度、KSS总评分、髌骨评分、患者满意度差异无统计学意义,而KSS功能评分两组之间差异有统计学意义,成形组优于置换组.而术后膝前疼痛发生率两者有差异但无统计学意义.术后X线片示髌股匹配程度、术后膝前疼痛发生率及髌骨相关并发症发生率两组间差异无统计学意义.结论 髌骨成形术在TKA中髌骨不置换时能够使髌股关节达到良好匹配,术后膝前疼痛发生率低,中短期疗效与髌骨置换相当.
目的 比較全膝關節置換術(total knee arthroplasty,TKA)中保留髕骨下進行髕骨成形與髕骨置換的術後臨床療效,探討膝關節置換中閤適的髕骨處理方法.方法 迴顧性分析2002年1月-2008年12月收治的共198例行TKA治療的單純骨關節炎患者,其中62例行髕骨置換術,136例行保留髕骨下髕骨成形術.術中對髕骨進行去除骨贅後進行成形,使之與原髕骨關節麵比較相近.術後定期隨訪進行美國膝關節協會評分(KSS)、Bristol髕骨評分、患者滿意度、膝關節活動度及分析術後膝前疼痛髮生率,併複查X線片瞭解內置物情況.結果 共125例穫得隨訪,其中置換組43例,成形組82例,隨訪時間36～80箇月,平均51箇月.兩組患者術後較術前各項評分明顯提高.術後1年隨訪時兩組患者術後膝關節活動度、KSS總評分、髕骨評分、患者滿意度差異無統計學意義,而KSS功能評分兩組之間差異有統計學意義,成形組優于置換組.而術後膝前疼痛髮生率兩者有差異但無統計學意義.術後X線片示髕股匹配程度、術後膝前疼痛髮生率及髕骨相關併髮癥髮生率兩組間差異無統計學意義.結論 髕骨成形術在TKA中髕骨不置換時能夠使髕股關節達到良好匹配,術後膝前疼痛髮生率低,中短期療效與髕骨置換相噹.
목적 비교전슬관절치환술(total knee arthroplasty,TKA)중보류빈골하진행빈골성형여빈골치환적술후림상료효,탐토슬관절치환중합괄적빈골처리방법.방법 회고성분석2002년1월-2008년12월수치적공198례행TKA치료적단순골관절염환자,기중62례행빈골치환술,136례행보류빈골하빈골성형술.술중대빈골진행거제골췌후진행성형,사지여원빈골관절면비교상근.술후정기수방진행미국슬관절협회평분(KSS)、Bristol빈골평분、환자만의도、슬관절활동도급분석술후슬전동통발생솔,병복사X선편료해내치물정황.결과 공125례획득수방,기중치환조43례,성형조82례,수방시간36～80개월,평균51개월.량조환자술후교술전각항평분명현제고.술후1년수방시량조환자술후슬관절활동도、KSS총평분、빈골평분、환자만의도차이무통계학의의,이KSS공능평분량조지간차이유통계학의의,성형조우우치환조.이술후슬전동통발생솔량자유차이단무통계학의의.술후X선편시빈고필배정도、술후슬전동통발생솔급빈골상관병발증발생솔량조간차이무통계학의의.결론 빈골성형술재TKA중빈골불치환시능구사빈고관절체도량호필배,술후슬전동통발생솔저,중단기료효여빈골치환상당.
Objective To compare the clinical effects of patellar resurfacing with patella reservation and patellaplasty in the total knee arthroplasty(TKA)for osteoarthritis so as to discuss appropriate management of patellas in TKA.Methods A retrospective study was conducted on 198 patients with osteoarthritis treated by TKA from January 2002 to December 2008.There were 62 patients managed by patellaplasty(patellaplasty group)and 136 patients by patellar resurfacing with patella reservation(patellar resurfacing group).The osteophytes of the patella were removed to make the articular surface of patellas similar to the primary one.Knee Society Score(KSS),Bristol patellar score,satisfaction survey and evaluation of joint range of motion(ROM)were performed during the regular follow-up.Incidence of postoperative anterior knee pain were analyzed and X-ray films were reviewed to understand the condition of the implants.Results A total of 125 patients were followed up,including 43 patients from the patellaplasty group and 82 from the patellar resurfacing group.The mean follow-up period was 51 months(range,36-80 months).Both groups showed significant improvement of each score postoperatively.No significant differences were found between the two groups regarding KSS score,patellar score and patient satisfaction in the follow-up one year later;but KSS function score in the patellar resurfacing group was superior to that in the patellaplasty group,with statistical difference.The incidence of anterior knee pain of the two groups had no statistical significance.Postoperative radiographs revealed no significant differences between the two groups concerning patellofemoral congruence,incidence of postoperative anterior knee pain or incidence of patellar related complications.Conclusion Patellar resurfacing with patella reservation for osteoarthritis in TKA can achieve satisfactory patellofemoral congruence and low incidence of intraoperative anterior knee pain,with comparable mid-term results with patellaplasty.
