髌股关节置换与全膝关节置换治疗单纯髌股关节炎的疗效比较

目的髌股关节置换(PFA)与全膝关节置换(TKA)对单纯髌股关节炎(PFOA)的疗效比较。方法回顾性分析2013年7月至2017年7月上海中医药大学附属光华医院因单纯PFOA入院行单侧PFA或TKA共172例病人的临床资料。采用倾向性评分匹配法对两组病人进行匹配，共46对病人匹配成功。比较两组的围手术期资料、随访结果、满意度、影像学资料。结果匹配后两组围手术期资料:PFA组显性出血量、隐性出血量、手术时间、住院天数小于TKA组，差异有统计学意义(P<0.05)；随访时间［PFA组(34±6.2)月(范围为28~84月)比TKA组(32±9.2)月(范围为24~71月)，P>0.05］。两组随访12月、24月、末次随访的牛津膝关节评分(OKS)及健康调查12项简表(SF-12)评分均较术前改善，差异有统计学意义(P<0.05)；但组内不同随访时间的两两比较，差异无统计学意义(P>0.05)；末次随访两组的髌股指数、适合角、外侧髌骨角差异无统计学意义(P>0.05)；PFA组与TKA组术后12月、末次随访满意度分别为95.6%、89%和91.3%、86.9%。术后并发症PFA组2例病人术后出现伤口脂肪液化感染，均予以表面清创。TKA组1例病人术后出现患侧关节红肿热痛，予以清创更换垫片，未发现假体松动者。结论TKA与PFA均能有效改善病人的功能和生活质量。且两组的功能情况和生活质量方面无差异。但PFA较TKA有更高的满意度、更少的出血量、更短的手术时间及更少住院天数。

Comparison of patellofemoral arthroplasty and total knee arthroplasty in the treatment of isolated patellofemoral osteoarthritis

Objective To compare the effects of patellofemoral arthroplasty (PFA) and total knee arthroplasty (TKA) in the treat?ment of isolated patellofemoral osteoarthritis.Methods The clinical data of 172 patients admitted for unilateral PFA or TKA due to isolated PFOA from July 2013 to July 2017 were retrospectively analyzed in Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine. There were 46 patients in the PFA group and 126 patients in the TKA group. The two groups were matched by propensity score matching method, and a total of 46 groups of patients were successfully matched. The perioperative data,follow-up results, satisfaction and imaging data of the two groups were compared.Results After matching, the perioperative data of the two groups were as follows: the dominant blood loss, the hidden blood loss, the operative time and the length of stay in the PFA group were smaller than those in the TKA group, and the differences were statistically significant (P<0.05). Follow-up results: Follow-up timePFA group (34±6.2) months (range: 28-84 months) versus TKA group (32±9.2) months (range: 24-71 months),P>0.05], The Oxford Knee Score (OKS) and the 12-item Short-form Health Survey scores(SF-12) of the two groups at 12 months, 24 months and the last fol?low-up were all improved compared with those before surgery, and the difference was statistically significant (P<0.05). However, pair?wise comparison of different follow-up time within the group showed no statistically significant difference (P>0.05). There was no signif?icant difference in patellofemoral index, angle of fit and angle of lateral patella between the two groups at the last follow-up (P>0.05).The satisfaction of PFA group and TKA group at 12 months and the last follow-up were 95.6 %, 89%, 91.3 %and 86.9 %, respectively.As for perioperative complications, two patients were infected with wound fat liquefaction after surgery in the PFA group, and surface debridement was performed. One patient in the TKA group had redness, swelling, heat and pain in the affected side of the joint after surgery. Debridement was performed to replace the gasket, and no prosthesis loosening was found.Conclusions TKA and PFA can ef?fectively improve the function and quality of life of patients.There is no difference in function and quality of life between the two groups.However, PFA has higher satisfaction, less blood loss, shorter operation time and shorter hospital stay than TKA.