髌骨置换治疗严重髌股关节炎在膝关节置换术中的临床应用分析

目的：探讨髌骨置换针对严重髌股关节炎在膝关节置换术中的应用及临床疗效。方法：2004年2月-2010年11月间行膝关节表面置换的126例（149例膝关节）。术前查X线（负重侧位、45。Rosenberg相、Merchant轴位相），对髌股关节炎分级并测量髌骨厚度和髌股间隙，从而预测出髌骨假体厚度，使重建后的髌股间隙不大于原间隙。均采用统一膝关节假体（smith＆nephew），由同一组医生完成。术中行髌骨截骨后假体置换，并在置换前后测量髌骨的运动轨迹。术后随访。膝关节评分（HSS评分），髌骨评分（Feller评分），结果应用SPSSl3．0软件行统计学分析。结果：术中股骨和胫骨假体试模安装完成后，行髌骨截骨安装假体，140例均髌骨轨迹良好，可以达到“nothumbtest”，9例采用了外侧支持带松解等操作，后髌骨轨迹良好。术后126患者均获得随访12个月，膝关节屈伸活动度平均110．5°（90°～125°），出现19髌前疼痛口服非甾体类药物逐渐缓解，无1例出现髌骨脱位、半脱位、髌骨坏死、髌骨坏死、髌骨骨折及皮肤坏死等。结论：对于严重的髌股关节炎行髌骨置换后可以更好的重建髌股关节，改善关节屈伸功能，减少髌骨的相关并发症。

Patellar Replacement to Treat Severe Patellofemoral Arthritis in the Knee Arthroplasty Clinical Analysis

Objective： To discuss serious patellofemoral arthritis in patella replacement in the application and clinical curative effect of knee arthroplasty. Methods. In February 2004 to November 2010, 126 cases of knee joint surface re- placement （149 cases of knee ioints）. Preoperative X-ray check （lateral load-bearing, 45°Rosenberg phase, phase break shaft）, classification and measurement of patellofemoral arthritis patellar thickness and patellofemoral gap, so as to predict the thickness of the patellar prosthesis, the reconstruction of patellofemoral clearance is not more than the origi- nal clearance. After intraoperative osteotomy patella prosthesis and trajectory measurements before and after the re- placement of the patella. Postoperative follow-up. Knee Score （HSS score）, patellar score （Feller score）, the results were analyzed by SPSS13. 0 software line. Results. After intraoperative femoral and tibial prosthesis tryout installation is complete, instaU the line patella prosthesis osteotomy, 140 cases were good patellar tracking can be achieved＂no thumb test＂, 9 cases with a lateral release and other operations, the patella track is good. 126 postoperative patients were followed up for 12 months, an average of 110. 5° knee flexion mobility （90° to 125°） ,appeared before the 19th pa- tellar oral nonsteroidal drugs gradually pain relief, and none of the patellar dislocation and subluxation, patellar necro- sis, patellar fracture and skin necrosis. Conclusion. For serious patellofemoral arthritis after patellar replacement can better reconstruction of patellofemoral joint, improve the function of joint flexion and extension, reduce the related com- plications of patella.