髌骨软骨退变分级对保留髌骨型全膝关节置换术疗效的影响

 目的 探讨髌骨软骨退变Outerbridge分级对保留髌骨型全膝关节置换术疗效的影响。方法 对2007年2月至2010年1月因膝关节退变性骨关节炎行保留髌骨型全膝关节置换术的151例进行回顾性分析。男65例，女86例；年龄56～82岁，平均(65±5.0)岁。随访时间2～5年，平均3.5年。术中对髌骨软骨退变分级的评定采用Outerbridge标准，统计末次随访时不同髌骨软骨退变分级患者的满意度及膝前痛发生情况，视觉模拟评分(visual analogue scale，VAS)>3分判定为有膝前痛；比较不同髌骨软骨退变分级患者的美国膝关节学会评分(Knee Society Scale，KSS)及髌骨评分。结果 OuterbridgeⅠ级18例、Ⅱ级36例、Ⅲ级62例、Ⅳ级35例。膝前痛发生率4.0%(6/151)，其中轻度疼痛4例、中度2例。无翻修病例，总体满意率96.7%(146/151)。不同髌骨软骨退变分级患者的满意度(H=5.54，P=0.14)、膝前痛发生率(H=0.56， P=0.91)、KSS膝评分(F=1.95， P=0.12)、功能评分(F=2.11，P=0.10)及髌骨评分(F=1.35， P=0.26)的差异均无统计学意义。结论 不同髌骨软骨退变分级患者行保留髌骨型全膝关节置换术后疗效无差异，对退变性骨关节炎患者行全膝关节置换术时无须置换髌骨。

Influence of cartilage degeneration grades of patellar to the clinical outcomes after total knee arthroplasty without patellar resurfacing

Objective To investigate the influence of cartilage degeneration grades of patellar on the clinical outcomes after total knee arthroplasty (TKA) without patellar resurfacing. Methods 151 patients performed TKA without patellar resurfacing from February 2007 to January 2010 were retrospective studied. There were 65 males and 86 females, with the mean age of 65±5.0 years (range, 56-82 years). The mean duration of follow-up was 3.5 years (range, 2-5 years). Intraoperatively, the cartilage degeneration was classified according to Outerbridge classification. At the final follow-up, the patients' satisfaction was evaluated, and the incidence of anterior knee pain was assessed using visual analogue scale (VAS). If VAS was more than 3 points, patient was defined suffered anterior knee pain. Compare KSS and patella score of patients with different grades of cartilage degeneration. Results The articular cartilage of the patella was graded according to Outerbridge: grade Ⅰ in 18 patients, grade Ⅱ in 36 patients, grade Ⅲ in 62 patients, and grade Ⅳ in 35 patients. At the final follow-up, the patients' satisfaction rate and the anterior knee pain rate was 96.7% (146/151) and 4.0% (6/151), respectively. In the patients with different grades of cartilage degeneration, the patient satisfaction rate (H=5.54, P=0.14), anterior knee pain rate (H=0.56, P=0.91), KSS (knee score: F=1.95, P=0.12; function score: F=2.11, P=0.10) and patella score (F=1.35, P=0.26) were not found to be significantly difference. Conclusion The differentiae grades of cartilage degeneration may not affect the clinical outcomes of TKA. TKA without patella resurfacing appears to be a reasonable option for degenerative osteoarthritis.