髌骨外侧关节面截骨对全膝关节置换术后膝前痛的影响

目的探讨髌骨外侧关节面截骨对全膝关节置换术(TKA)术后膝前痛的影响。方法回顾性分析首都医科大学附属北京朝阳医院2015年3月—2018年6月528例接受TKA患者的临床资料,其中男96例、女432例,年龄54~83(68.27±7.29)岁。术中行单纯髌骨周围骨赘清除274例(骨赘清除组),行髌骨外侧关节面截骨254例(关节面截骨组)。比较两组患者年龄、性别、BMI、手术时间及髋膝踝角等基线资料,比较术前与术后髌骨倾斜角、Blackburen-Peel(BP)指数、外侧髌骨角、髌股指数,以及术后6个月美国膝关节协会评分(KSS)、膝关节活动度及膝前痛的发生率。结果两组患者基线资料比较差异均无统计学意义(P值均>0.05)。骨赘清除组和关节面截骨组比较,术前髌骨倾斜角、BP指数、外侧髌骨角及髌股指数的差异均无统计学意义(P值均>0.05),术后1个月髌骨倾斜角(15.00°±1.70°与13.88°±2.87°)、外侧髌股角(6.80°±4.94°与10.72°±4.37°)、髌股指数(2.02±0.43与1.56±0.46)差异均有统计学意义(t=5.324、9.672、11.995,P值均<0.01)。术前与术后1个月两组患者BP指数组内比较,差异无统计学意义(P>0.05);骨赘清除组术前与术后1个月髌骨倾斜角、外侧髌股角及髌股指数差异均有统计学意义(t=2.917、4.861、12.244,P值均<0.05),关节面截骨组外侧髌骨角(8.02°±3.88°和10.72°±4.37°)差异有统计学意义(t=8.928,P<0.05)。两组患者术后6个月KSS及膝关节活动度均较术前改善,差异有统计学意义(P值均<0.05),但两组间比较差异均无统计学意义(P值均>0.05)。关节面截骨组患者术后6个月膝前痛的发生率为0.8%(2/254),低于骨赘清除组(5.5%,15/274),差异有统计学意义(χ2=7.995,P<0.05)。结论TKA术中髌骨外侧关节面截骨可以在影像学上有效减少髌骨的倾斜角度,改善膝关节术后功能,减少术后膝前痛的发生率。

Effect of lateral facetectomy of patella on anterior knee pain after total knee arthroplasty

Objective To investigate the effect of lateral patellar facetectomy on anterior knee pain after total knee arthroplasty (TKA) .Methods Clinical data of 528 patients who underwent TKA in Beijing Chao-Yang Hospital from March 2015 to June 2018 were retrospectively analyzed, including 96 males and 432 females, aged 54-83 (68.27±7.29) years. The patients were divided into the osteophyte removal (OR) group, which included 274 patients who underwent OR in the patella, and the lateral patellar facetectomy (LF) group, which was composed of 254 patients who underwent LF. Baseline data, such as age, sex distribution, body mass index, operation time, and hip-knee-ankle angle, were recorded. Clinical outcomes were evaluated on the basis of patellar tilting angle, Blackburne-Peel (BP) index, Laurin angle, patellofemoral index, American Knee Society Score (KSS), range of motion, and incidence of anterior knee pain.Results Baseline information between the two groups was insignificantly different (all P values＞0.05). Laurin angle, BP index, patellar tilting angle, and patellofemoral index were not statistically different (all P values＞0.05) between the two groups. However, postoperative patellar tilting angle (15.00°±1.70° versus 13.88°±2.87°), Laurin angle (6.80°±4.94° versus 10.72°±4.37°), and patellofemoral index (2.02±0.43 versus 1.56±0.46) were significantly different from the preoperative data (t=5.324, 9.672, 11.995, all P values＜0.01). Preoperative and postoperative Laurin angle, patellar tilting angle, and patellofemoral index in the OR group were statistically different (t=2.917, 4.861, 12.244, all P values＜0.05). Meanwhile, postoperative BP index was similar to preoperative BP index (P>0.05). Laurin angle was significantly different before and after operation (t=8.928, P<0.05). KSS and range of motion were significantly improved postoperation in both groups (all P values＜0.05). By contrast, the preoperative and postoperative KSS and range of motion of the two groups were not statistically different (all P values＞0.05). The incidence of anterior knee pain in the LF group was 0.8% (2/254), which was significantly lower than that in the OR group (5.5%, 15/274; χ²=7.995, P<0.05).Conclusions Compared with OR in the patella, LF can achieve better postoperative imaging parameters, better postoperative functions, and lower incidence of anterior knee pain