CAJ | 학술논문

目的探讨髌股关节置换术治疗单纯髌股关节骨关节炎的疗效和影响因素.方法回顾性分析2006年3月至2014年12月,采用髌股关节置换术治疗并获得随访的18例单纯髌股关节骨关节炎患者资料,男3例,女15例;年龄46～74岁,平均54岁;术前美国特种外科医院膝关节评分(hospital for special surgery knee score,HSS)为44～63分,平均(53.28±5.71)分;疼痛视觉模拟评分(visual analogue scale,VAS)为4～7分,平均(5.33±0.99)分.术前根据临床症状、体征和影像学资料严格把握手术指征,其中11例采用AVON髌股关节假体(Stryker公司),7例采用Gender Solutions髌股关节假体(Zimmer公司).术后第1天患膝即开始行主动和被动功能康复锻炼.结果 18例患者术后均获得随访,随访时间6～104个月,平均63.98个月.VAS,术后1个月(1.17±0.79)分(范围,0～3分),术后3个月(0.72±0.67)分(范围,0～2分),术后9个月疼痛基本消失;HSS,术后1个月(70.06±6.33)分(范围,61～80分),术后3个月(86.06±5.12)分(范围,77～95分),术后9个月(91.39±4.83)分(范围,82～97分),末次随访(92.06±4.05)分(范围,84～97分),其中优15例、良3例,优良率100％,较术前有明显改善.患者主观满意率94.4％(17/18).1例患者术后2年再次出现上下楼梯时膝前疼痛,给予非甾体类抗炎药和适当减少活动后症状缓解.随访期间无一例患者出现切口感染、髌骨脱位、假体松动等并发症.结论髌股关节置术后疗效与手术适应证、假体设计、手术技巧等因素密切相关,在选用合适的髌股关节假体、严格把握手术适应证、掌握好手术技巧及积极术后康复功能锻炼等基础上,采用髌股关节置换术治疗单纯髌股关节骨关节炎可以获得良好的疗效.
목적 탐토빈고관절치환술치료단순빈고관절골관절염적료효화영향인소.방법 회고성분석2006년3월지2014년12월,채용빈고관절치환술치료병획득수방적18례단순빈고관절골관절염환자자료,남3례,녀15례;년령46～74세,평균54세;술전미국특충외과의원슬관절평분(hospital for special surgery knee score,HSS)위44～63분,평균(53.28±5.71)분;동통시각모의평분(visual analogue scale,VAS)위4～7분,평균(5.33±0.99)분.술전근거림상증상、체정화영상학자료엄격파악수술지정,기중11례채용AVON빈고관절가체(Stryker공사),7례채용Gender Solutions빈고관절가체(Zimmer공사).술후제1천환슬즉개시행주동화피동공능강복단련.결과 18례환자술후균획득수방,수방시간6～104개월,평균63.98개월.VAS,술후1개월(1.17±0.79)분(범위,0～3분),술후3개월(0.72±0.67)분(범위,0～2분),술후9개월동통기본소실;HSS,술후1개월(70.06±6.33)분(범위,61～80분),술후3개월(86.06±5.12)분(범위,77～95분),술후9개월(91.39±4.83)분(범위,82～97분),말차수방(92.06±4.05)분(범위,84～97분),기중우15례、량3례,우량솔100％,교술전유명현개선.환자주관만의솔94.4％(17/18).1례환자술후2년재차출현상하루제시슬전동통,급여비치체류항염약화괄당감소활동후증상완해.수방기간무일례환자출현절구감염、빈골탈위、가체송동등병발증.결론 빈고관절치술후료효여수술괄응증、가체설계、수술기교등인소밀절상관,재선용합괄적빈고관절가체、엄격파악수술괄응증、장악호수술기교급적겁술후강복공능단련등기출상,채용빈고관절치환술치료단순빈고관절골관절염가이획득량호적료효.
Objective To explore the effect and factors of patellofemoral arthroplasty (PFA) for isolated patellofemoral osteoarthritis.Methods Data of 18 patients (3 males,15 females) with isolated patellofemoral osteoarthritis underwent PFA from March 2006 to December 2014 were retrospectively analyzed.There were 3 males and 15 females with a mean age of 54 years (range,46-74 years).It was strict to grasp the surgical indications according to the clinical symptoms,signs and imaging data preoperatively.11 patients were operated with AVON patellofemoral prosthesis (Stryker Inc.) and the other 7 patients were operated with the Gender Solutions patellofemoral prosthesis (Zimmer Inc.).Active and passive functional rehabilitation exercise was encouraged at the early stage after operation.Visual analogue scale (VAS) was 5.33±0.99 (range,4-7) and hospital for special surgery knee score (HSS) was 53.28±5.71 (range,44-63) before operation.Results The mean duration of follow-up was 63.98 months (range,6-104 months).VAS after operation for 1 and 3 months were 1.17±0.79 (range,0-3) and 0.72±0.67 (range,0-2),and the pain was almost relieved after 9 months.HSS after operation for 1,3,9 months were 70.06±6.33 (range,61-80),86.06±5.12 (range,77-95) and 91.39±4.83 (range,82-97).HSS score of the latest follow-up was 92.06±4.05 (range,84-97),which was improved obviously from the preoperative ones.The excellent and good rate was 100％ (excellent 15 cases,good 3 cases).The satisfactory rate was 94.4％ (17/18).Only one case got slightly knee pain when walking up and down the stairs after 2 years,and the pain was relieved after being administered with NSAIDs and rest.No incision infection,rupture,prosthesis supported bone fracture,prosthesis loosening and other complication was occurred during the follow-up period in the other patients.Conclusion The clinical outcomes of PFA are strictly related to surgical indications,implant design and appropriate surgical technique.Therefore,based on the appropriate PFA implants,strict surgical indications,appropriate patients,excellent operation skills and actively functional rehabilitation exercise,PFA could treat the isolated patellofemoral osteoarthritis effectively.