全膝关节置换中髌骨成形术的临床应用

目的:回顾性分析比较全膝人工关节置换术(total knee arthroplasty, TKA)中髌骨成形与髌骨置换的临床疗效. 方法:自1999年5月至2004年1月住院治疗施行TKA且资料完整的骨关节炎及类风湿性关节炎203例患者,按髌骨不同处理方式分为两组:髌骨成形组及髌骨置换组,术后随访11～68个月,平均28.1个月.结果:两组患者术后膝关节评分及髌骨功能评分改善值均无显著性差异,随访时两组髌骨功能评分及膝关节屈伸活动范围亦无显著性差异.成形组髌骨并发症发生率显著低于置换组(P<0.01).成形组患者满意率高于置换组(P<0.05).随访时X线片测量髌骨倾斜角及外翻角,发现两组小角度的倾斜及外翻的发生率均较高,但两组之间无显著性差异.结论:全膝关节置换中采用髌骨成形术,尽可能地保留了髌骨骨量,适用于任何有股骨滑车的膝关节假体,术后短期疗效可靠、髌骨并发症低、患者满意率高,但中、远期疗效需进一步观察.

Clinical application of patella arthroplasty in total knee arthroplasty

Objective:To analyze and compare the clinical outcomes of total knee arthroplasty with patella arthroplasty and patella replacement. Methods: From May 1999 to January 2004, 251 knees in 203 patients (45 males and 158 females; age range: 25 to 91 years, average 62.8 years) with osteoarthritis (206 knees) and rheumatoid arthritis (45 knees) were evaluated using a questionnaire during physical examination. Totally 137 knees underwent patella arthroplasty and 114 underwent patella replacement, with a mean follow-up of 28.1 months. The patients were scored using KSS Score, Feller Score and British Orthopedics Association Patient-satisfaction Score. Results: Patella arthroplasty and replacement showed no obvious difference in post-operative improvement of the knee score, knee function score, patella function score and range of flexion and extent of knee. Compared with patella replacement group, patella arthroplasty group had a higher patient satisfaction rate (P<0.05) and a lower complication incidence of patella (P<0.01). X-ray results showed higher incidences of patella tilt and valgus alignment in both groups but with no significant difference between the 2 groups. Conclusion: Patella arthroplasty in total knee arthroplasty can keep patellar bone as much as possible and is suitable for all kinds of artificial knee joints with femoral trochlear. With reliable short-term clinical outcome and lower patella complication rate, patella arthroplasty had a high satisfaction rate, but its mid-term and long-term clinical outcome need further observation.