全膝关节置换术治疗膝骨关节炎合并固定性髌骨脱位

目的评估全膝关节置换术治疗膝骨关节炎合并固定性髌骨脱位患者的临床疗效。方法对6例膝骨关节炎合并固定性髌骨脱位的患者(8膝)行全膝关节置换术。采用标准内侧髌旁入路,并行“+”形松解外侧支持带,常规髌骨置换,使用非限制性后稳定假体。比较手术前后的HSS评分和疼痛VAS评分,测量股骨胫骨角(FTA)和伸膝迟滞。结果患者均获得随访,时间1~8年。HSS评分从术前25~63分提高到术后1年75~94分。VAS评分从术前5~8分下降至术后1年0~3分。FTA从术前161°~173°改善至术后1年173°~175°。术前有10°~25°的伸膝迟滞,术后基本消失。结论采用标准内侧髌旁入路结合外侧结构的松解作全膝关节置换术治疗膝骨关节炎合并固定性髌骨脱位可获得良好的临床疗效。

Total knee arthroplasty for knee osteoarthritis combined with permanent irreducible dislocation of patella

Objective To assess the outcomes of total knee arthroplasty(TKA)for patients with severe knee osteoarthritis(KOA)combined with permanent irreducible dislocation of patella(PIDP).Methods Six patients(8 knees)with KOA combined with PIDP were treated with TKA.TKA was performed with standard medial parapatellar approach.Lateral retinaculum was released with“+”shape.Patella were all resurfaced.Posterior stability(PS)prothesis were used.HSS score,visual analogue scale(VAS),femorotibial angle(FTA)and extension lag before and after operation was recorded.Results All cases were followed up for 1~8 years.The HSS scores were improved significantly from 25~63 points preoperatively to 75~94 points at 1 year postoperation.VAS was decreased from 5~8 points to 0~3 at 1 year postoperation.FTA was also improved from 161°~173°to 173°~175°.Extension lag was 10°~25°preoperatively,which almost disappeared at 1 year postoperation.Conclusions KOA patients with PIDP can achieve good outcomes through TKA using standard medial parapatellar approach combined with lateral release.