全膝关节置换术后膝关节线改变与膝前痛的相关性

目的 探讨全膝关节置换术后膝关节线改变与膝前痛的相关性.方法 回顾性分析2008年1月至2010年12月因膝关节骨关节炎行初次全膝关节置换的76例患者的病例资料,男11例,女65例；年龄47～83岁,平均(68.88±7.61)岁.术中应用PFC后稳定型固定平台膝关节假体.术后每12个月定期门诊随访一次.根据Figgie膝关节线测量方法对术前及随访时的关节线进行测量,并计算术前、术后关节线的变化.关节线升高为正值,关节线降低为负值.采用Feller评分法评估术前及随访时的髌骨功能.评估术后24个月的关节线改变水平与Feller髌骨评分的相关性.结果 关节线改变-6.8～10.44 mm,平均(2.69±3.31) mm.随膝关节线升高,Feller髌骨评分呈下降趋势；关节线改变值与Feller髌骨评分呈负相关(r=-0.763,P=0.000).随关节线降低,Feller髌骨评分呈下降趋势；关节线改变值与髌骨评分呈正相关(r=0.914,P=0.000).术后12、24个月关节线改变4 mm以内的患者(55例)Feller髌骨评分均高于关节线改变大于4 mm的患者(21例),差异有统计学意义(t=12.648,P=0.000；t=11.775,P=0.000).结论 对后稳定型固定平台膝关节假体,关节线改变与膝前痛具有相关性,保持关节线变化在±4 mm以内有利于恢复膝关节功能.

Correlation analysis between knee joint line and anterior knee pain after total knee arthroplasty

Objective To investigate the correlation between knee joint line and anterior knee pain after total knee arthroplasty (TKA). Methods From January 2008 to December 2010, 76 patients with osteoarthritis underwent primary TKA in our hospital, including 11 males and 65 females, aged from 47 to 83 years (average, 68.88±7.61 years). Fixed-bearing posterior stabilized TKA (PFC) was used in all patients. All patients were followed up every 12 months after TKA. According to the Figgie's method, pre- and post-operative knee joint line was measured, and the changes of pre- and post-operative knee joint line were calculated. If the knee joint line was elevated, it was defined as positive; on the contrary, it was defined as negative. The Feller's patellar score was used to assess pre- and post-operative patellar function. The correlation between joint line level and Feller's patellar score was analyzed 24 months after operation. Results The joint line level ranged from -6.8 to 10.44 mm (average, 2.69±3.31 mm). With the rise of the joint line, the patient's patella score decreased. There is a negative correlation between the elevated joint line level and Feller's patellar score (r=-0.763, P=0.000). The Feller's patellar score decreased with the fall of joint line level, and there is a positive correlation between them (r=0.914, P=0.000). The Feller's patellar score was higher in patients whose joint line change was less than 4 mm than that in patients whose joint line change was greater than 4 mm (t=12.648, P=0.000; t=11.775, P=0.000). Conclusion The joint line change was correlated to anterior knee pain after TKA with fixed-bearing posterior stabilized prosthesis. The joint line change less than 4 mm can result in a better knee joint function.