不置换髌骨的活动平台膝关节置换术后膝前痛的中期随访

目的 比较行固定平台和活动平台人工膝关节置换的患者术后的中期膝前痛情况。方法 选取2006至2009年于首都医科大学附属北京同仁医院骨科行固定平台和活动平台膝关节置换的患者作为研究对象，将其分为固定平台组和活动平台组。所有患者均未置换髌骨。记录患者术前术后膝前痛发生率、膝前痛评分、髌骨评分、KSS功能评分（Knee Society Function Score），并进行术前术后和两组间的比较。拍摄术后膝关节正侧位和Merchant位X线片，观察髌骨位置情况。结果 共63人、85膝纳入研究。其中活动平台组31人、45膝，随访时间3.9~7.6年，平均（5.9±1.1）年。固定平台组30人、40膝，随访4.2~8.1年，平均（6.4±1.3）年。两组患者术后膝前痛评分、髌骨评分、KSS功能评分均较术前有明显提高，但两组患者间术后上述评分差异无统计学意义。两组患者间术后膝前痛发生率差异也无统计学意义。两组患者术后X-ray均未显示明显的髌骨脱位或半脱位。结论 非置换髌骨的活动平台和固定平台膝关节置换术均可以有效地缓解膝前痛、恢复膝关节功能，术后中期效果满意。相比固定平台假体，活动平台假体的应用并未显著地改善术后膝前痛情况。

Medium-term follow up the anterior knee pain of mobile and fixed bearing total knee arthroplasty without patella replacement

Objective Evaluate the medium-term anterior knee pain result of total knee arthroplasty (TKA) using mobile-bearing (MB) and fixed-bearing (FB) prosthesis.Methods The patients who suffer from osteoarthritis or rheumatoid arthritis and receiving TKA with MB and FB prosthesis during 2006-2009 were followed up,then divided them into two corresponding groups(Group MB,Group FB). All the patients were not be replaced the patella.The postoperative anterior knee pain incidence,Knee Society Function Score,Patellar Score and the Anterior Knee Pain Score were collected,which were compared with preoperation and with another group. The Anterior-Posterior, lateral and Merchant position X-ray pictures were taken to evaluate the patella position.Results 63 patients,85 knees were followed up. The MB group contain 31 patients,45 knees,the mean follow-up period was (5.9±1.1) years(3.9-7.6 years).The FB group contain 30 patients,40 knees,the mean follow-up period was (6.4±1.3) years(34.2-8.1 years).The postoperative scores were significantly higher than preoperation,but there are no differences between the two groups,as well as the anterior knee pain incidence.No patella dislocation or subluxation were found in the postoperative X-ray examination. Conclusion Both mobile-bearing and fix-bearing TKA can relieve anterior knee pain effectively and recovery knee function,the medium-term clinical results are satisfactory.But comparing with FB,the application of the MB prosthesis did not improve the anterior knee pain more.