全膝关节置换术中髌骨置换与髌骨截骨疗效的病例对照研究

目的：比较人工全膝关节置换术髌骨截骨和髌骨置换的疗效,为临床治疗提供参考.方法：2004年4月至2011年4月行人工全膝关节置换术52例（54膝）,分为髌骨置换组和髌骨截骨组.髌骨置换组24例24膝,其中男13例,女11例,年龄53～78岁;髌骨截骨组28例30膝,男16例,女12例,年龄55～79岁.术后对其进行临床评价,包括膝关节评分（HSS评分系统）,髌骨评分（Feller评分标准）,膝关节活动度（ROM）,患者满意度,髌骨相关并发症.结果：术后随访20～80个月,平均56个月.髌骨置换组HSS评分由术前38.4±8.2提高为末次随访时的91.2±8.6,Feller评分由13.6±6.2提高为25.2±4.2,膝前痛分数由3.9±3.2提高为11.2±3.7,ROM由（78±26）°提高为（108±18）°.髌骨截骨组HSS评分由术前39.5±8.4提高为末次随访时的91.0±8.5,Feller评分由13.4±6.5提高为25.6±4.0,膝前痛分数由3.7±3.1提高为11.3±3.6,ROM由（76±27）°提高为（110±19）°.术后满意度髌骨置换组91％,髌骨截骨组89％;髌骨相关并发症髌骨置换组16.7％,髌骨截骨组10.0％.两组术后HSS评分、Feller评分、膝前痛分数及ROM比较差异无统计学意义,患者满意度比较差异无统计学意义,两组髌骨相关并发症比较差异有统计学意义,髌骨截骨组低于髌骨置换组.结论：全膝关节置换术中髌骨置换与髌骨截骨均能明显改善膝关节功能和减轻疼痛,髌骨相关并发症与髌骨的处理方式有关,但术后膝前痛及患者满意度与髌骨的处理方式无关.

Comparison of therapeutic effects between patella replacement and patella osteotomy in total knee arthroplasty: a case-control study

To compare therapeutic effects between patella replacement and patella osteotomy in total knee arthroplasty. Methods：From April 2004 to April 2011, 52 patients （54 knees） were enrolled in the clinical trail of total knee arthroplasty, who received patella replacement （24 knees ,including 13 males and 11 females,ranging in age from 53 to 78 years old or patella osteotomy （30 knees ,including 16 males and 12 females ,ranging in age from 55 to 79 years old. The average follow-up period was 56 months,ranging from 20 to 80 months. The American HSS Score for knee,the Feller score for patella,range of motion （ROM） for knee,patient satisfaction and complications related to the patella were used to evaluate therapeutic effects. Results：In the patella replacement group, the preoperative and final follow-up HSS scores of patients were 38.4±8.2 and 91.2 ±8.6 respectively ; Feller scores were 13.6±6.2 and 25.2±4.2 ; scores of anterior knee pain were 3.9±3.2 and 11.2±3.7 ; ROM were （78±26） °and （ 108 ± 18 ）°. In the patella osteotomy group, the preoperative and final follow-up HSS scores of patients were 39.5±8.4 and 91.0 ±8.5 respectively ;Feller scores were 13.4±6.5 and 25.6±4.0 ;scores of anterior knee pain were 3.7±3.1 and 11.3±3.6 ; ROM were （76±27） °and （ 110±19 ）°. In the patella replacement group, patient＇ s satisfaction was 91% ,and complication related to the patella was 16.7% ;in the patella osteotomy group ,patient＇s satisfaction was 89% ,and complications related to the patella was 10.0%. There were no statistically significant differeneces in final follow-up HSS scores, Feller scores, scores of anterior knee pain and ROM between the two groups. However, there was no significant difference of patient＇ s satisfaction between them. There was statistically significant differenece of patella-related complications between the two groups, and the complication rate in the patella replacement group was higher than that in the patella osteotomy group. Conclu- sion ：Total knee arthroplasty with patella replacement or patella osteotomy dramatically relieves pain and improves the knee function. Patella-related complications are associated with its treatment methods, but post-operative anterior knee pain and patient＇ s satisfaction are not related to treatment methods of the patella.