CAJ | 학술논문

目的探讨单侧髌骨粉碎性骨折行髌骨完全切除后对双侧膝关节远期功能的影响. 方法回顾性分析1980年1月至2003年4月行髌骨完全切除术治疗的24例单侧髌骨粉碎性骨折患者资料,男22例,女2例;平均年龄为49.9岁(21 ～83岁);左侧13例,右侧11例.末次随访时测量患者双侧股四头肌肌力、髌骨上缘近端10、20 cm处大腿周径,应用美国膝关节协会评分(AKS)标准评定膝关节功能,并行膝关节X线摄片及磁共振成像(MRI)检查以评估膝关节退变情况. 结果 24例患者术后获平均17.3年(11～26年)随访.末次随访时患者健侧髌骨上缘近端10、20 cm处大腿周径平均分别为(44.2±6.5)、(58.2±5.8) cm,患侧分别为(42.1±5.9)、(57.0±4.9)cm,两侧比较差异均无统计学意义(P＞0.05).双侧股四头肌肌力均为5级.健、患侧膝关节AKS评分平均分别为(159.2±11.6)、(155.0±14.9)分,两侧比较差异无统计学意义(t=1.998,P=0.058).骨关节炎按Kellgren-Lawrence分级:两侧骨关节炎退变程度比较差异无统计学意义(P＞0.05).软骨损伤按Recht标准分级:健侧膝关节软骨损伤重于患侧,差异有统计学意义(P＜0.05).结论单侧髌骨粉碎性骨折行髌骨完全切除术后,患侧股四头肌肌力及膝关节功能远期可以恢复至与健侧相当的水平,但会加速健侧膝关节的退变.
목적 탐토단측빈골분쇄성골절행빈골완전절제후대쌍측슬관절원기공능적영향. 방법 회고성분석1980년1월지2003년4월행빈골완전절제술치료적24례단측빈골분쇄성골절환자자료,남22례,녀2례;평균년령위49.9세(21 ～83세);좌측13례,우측11례.말차수방시측량환자쌍측고사두기기력、빈골상연근단10、20 cm처대퇴주경,응용미국슬관절협회평분(AKS)표준평정슬관절공능,병행슬관절X선섭편급자공진성상(MRI)검사이평고슬관절퇴변정황. 결과 24례환자술후획평균17.3년(11～26년)수방.말차수방시환자건측빈골상연근단10、20 cm처대퇴주경평균분별위(44.2±6.5)、(58.2±5.8) cm,환측분별위(42.1±5.9)、(57.0±4.9)cm,량측비교차이균무통계학의의(P＞0.05).쌍측고사두기기력균위5급.건、환측슬관절AKS평분평균분별위(159.2±11.6)、(155.0±14.9)분,량측비교차이무통계학의의(t=1.998,P=0.058).골관절염안Kellgren-Lawrence분급:량측골관절염퇴변정도비교차이무통계학의의(P＞0.05).연골손상안Recht표준분급:건측슬관절연골손상중우환측,차이유통계학의의(P＜0.05).결론 단측빈골분쇄성골절행빈골완전절제술후,환측고사두기기력급슬관절공능원기가이회복지여건측상당적수평,단회가속건측슬관절적퇴변.
Objective To study the long-term clinical and radiological performance of bilateral knees after total patellectomy for comminuted fracture of unilateral patella.Methods Twenty-four patients with comminuted fracture of unilateral patella underwent total patellectomy from January 1980 through April 2003.They were 22 males and 2 females,with an average age of 49.9 years.Involved were 13 left and 11 right knees.At the final follow-up,the myodynamia of quadriceps femoris and girths of thigh at the 10 cm and 20 cm proximal ends of the patella were measured.Knee function was scored according to the American Knee Society (AKS) system.X-ray and MRI were performed for bilateral knees to judge the degeneration.The above mentioned indicators were also measured in an age and sex-matched control group composed of 16 healthy volunteers.Results The patients were followed up for 17.3 years on average (from 11 to 26 years).At the final follow-up,the girths of thigh at the 10 cm and 20 cm proximal ends of the patella were respectively 44.2 ± 6.5 cm and 58.2 ± 5.8 cm for non-surgical knees,and 42.1 ± 5.9 cm and 57.0 ± 4.9 cm for surgical ones,showing no significant difference between the 2 sides (P ＞ 0.05).The myodynamia of quadriceps femoris for non-surgical and surgical knees were all grade 5.The AKS scores for the 2 sides were not significantly different (159.2 ± 11.6 points versus 155.0 ± 14.9 points) (t =1.998,P =0.058).There was no significant difference between the 2 sides regarding osteoarthritis degeneration (P ＞ 0.05),but the cartilage lesion was significantly worse at the non-surgical side than at the surgical side (P ＜ 0.05).Conclusion In patients after total patellectomy for comminuted fracture of unilateral patella,although the function of the surgical knee can restore to a similar level of the contralateral side,the non-surgical knee may present with degeneration.