减少髌骨厚度对膝关节置换术后髌股关节功能的影响

目的探讨减少髌骨厚度对膝关节置换术后髌股关节功能的影响。 方法收集2014年7月至2016年7月间在作者本院行单侧初次全膝关节置换术的122病例资料，分为常规髌骨打磨组与减少髌骨厚度组，术后随访2年。观察比较两组患者的一般情况、术前术后膝关节功能评分（HSS评分）、髌骨评分（Feller评分）、疼痛视觉模拟评分（VAS评分），复查X线观察髌骨倾斜角、合适角。 结果术前两组一般资料无差异性，术前的HSS评分及Feller评分比较，差异无统计学意义。两组患者术后3个月、术后半年、术后1年及术后2年HSS评分、Feller评分、疼痛评分（VAS）及膝关节活动度经过重复测量设计的方差分析，显示两组的组间差异有统计学意义（P<0.05），组别与时间点间存在交互作用，减少髌骨厚度组及常规髌骨打磨组在除术后1月外的其余术后各时间点间差异均有统计学意义。术后随访X线的髌骨倾斜角及合适角的对比无差异性。 结论全膝关节置换术可明显改善膝关节功能，如适当减少髌骨厚度，减轻髌股关节压力，较常规髌骨打磨更有利于改善髌股关节功能。但减少髌骨厚度的远期疗效及可能出现的并发症有待进一步随访、观察。

Effect of decreasing patella thickness on patellofemoral joint function after total knee arthroplasty

ObjectiveTo investigate the effect of decreasing patella thickness on patellofemoral joint function after total knee arthroplasty. MethodsFrom July 2014 to July 2016, 122 patients underwent unilateral primary total knee arthroplasty in our hospital were divided into routine patellar polishing group and reduced patellar thickness group. The patients were followed up for 2 years. The general condition, preoperative and postoperative knee function score (HSS score), patellar score (Feller score), visual analogue pain score (VAS) were observed and compared between the two groups. Patellar tilt angle and suitable angle were observed by X-ray. ResultsThere was no difference in general data between the two groups before operation. There was no significant difference in HSS and Feller score between the two groups before operation. The HSS score, Feller score, VAS and knee joint mobility of the two groups at 3 months, 6 months, 1 year and 2 years after surgery were analyzed by variance analysis with repeated measurements (P<0.05). There was interaction between groups and time points, and difference was significant between the group of reducing patellar thickness and the group of routine patellar polishing at all time points except 1 month after operation. ConclusionsTotal knee arthroplasty can significantly improve the function of the knee joint.If the thickness of patella is reduced properly, the pressure of patellofemoral joint is reduced, the patellofemoral joint function can be improved better than that of conventional patellar polishing. But the long-term efficacy and possible complications of reducing patellar thickness need further follow-up.