全膝关节置换术中髌骨置换对骨性关节炎患者早期疗效及膝前痛的影响

目的：探讨全膝关节置换术中是否进行髌骨置换对骨性关节炎患者的临床疗效及术后疼痛的影响。方法笔者采用随机数字表法将骨科2011年5月～2013年7月收治的93例行人工全膝关节置换术患者分为髌骨置换组43例和未置换组50例，比较两组患者治疗前与治疗后不同时间的相关指标变化差异。结果术前髌骨置换组与非置换组的膝关节KSS（美国膝关节协会）评分、Feller评分差异不显著（ P＞0．05）；术后第3、6、12个月髌骨置换组膝关节KSS评分、Feller评分显著高于非置换组（P＜0．05）；术前髌骨置换组与非置换组的膝关节视觉模拟评分（VAS）差异不显著（P＞0．05）；术后第3、6、12个月髌骨置换组膝关节VAS评分显著低于非置换组（P＜0．05）；两组患者术前、术后的胫股角，髌韧带比值，关节活动度ROM屈、伸值在两组间比较差异均不显著（ P＞0．05）；术后第12个月两组患者的胫股角、髌韧带比值，关节活动度ROM屈、伸值较治疗前均显著好转（ P＜0．05）。结论全膝关节置换术中进行髌骨置换对改善膝关节功能评分、髌骨评分、术后疼痛评分均有显著的效果。

Early clinical effect of patellar replacement on anterior knee pain in patients with knee osteoarthritis after total knee arthroplasty

Objective To discuss the clinical efficacy and postoperative pain of patellar replacement in pa-tients with osteoarthritis in total knee arthroplasty.Methods A total of 93 cases with total knee arthroplasty in our hospital from May 2011 to Jul.2013 were randomly selected and divided into replacement group( n=43) and non-replacement group( n=50) by the stochastic indicator method.The differences of related indicators at different time points between the two groups were compared.Results The differences of KSS knee score and Feller score be-tween the preoperative replacement group and non-replacement group were not significant(P>0.05);3,6 and 12 months after the surgery,the KSS knee score and Feller score of the replacement group were significantly higher than that of the non-replacement group(P<0.05);the differences of knee VAS score between the preoperative replace-ment group and non-replacement group were not significant(P>0.05);3,6 and 12 months after the surgery,the knee VAS score of the replacement group were significantly lower than that of the non-replacement group ( P <0.05 );differences of the tibiofemoral angle,patellar ligament ratio,and ROM values between the two groups were not significant before and after the surgery;12 months after the surgery,significant improvement of the tibiofemoral an-gle,patellar ligament ratio and ROM values in both groups were observed compared to those before the operation (P<0.05).Conclusion Patellar replacement in the total knee arthroplasty showed a significant effect in impro-ving knee function score,patellar score and postoperative pain score.