全膝关节置换过程中髌股关节轨迹不良的处理

背景：人工全膝关节置换后膝前痛的主要原因是髌股关节并发症。目的：探讨全膝关节置换过程中髌股关节轨迹不良的处理方法。方法：31例32膝在全膝关节置换过程中出现髌股关节轨迹不良,均为女性,年龄53-85岁,平均68.5岁,病程8-25年,平均22.3年,其中骨性关节炎27例28膝,类风湿性关节炎4例4膝。膝外翻角12°-32°,平均20°;Q角为13°-23°,平均16°。采用正确截骨,调整假体位置,髌骨内外侧软组织平衡,或加行Goldthwait-Roux术进行纠正。结果与结论：随访时间12-120个月。膝关节平均活动度数(98.2±10.3)°。KSS评分从置换前平均35分提高到置换后平均81分;KSS功能评分从置换前平均34分提高到置换后平均83分。置换后切口均Ⅰ期愈合,未发生皮肤坏死、切口感染等并发症。屈膝45° Knutsson髌骨轴位X射线片检查无髌骨倾斜、半脱位或脱位。结果说明在全膝关节置换过程中出现髌股关节轨迹不良时采用稳定性假体,正确截骨及调整假体位置,髌骨内外侧软组织平衡,或加行Goldthwait-Roux术,可取得比较满意的疗效。

Treatment for patellofemoral maltracking in total knee arthroplasty

BACKGROUND:The complication of patellofemoral joint is the main cause of anterior knee pain after total knee arthroplasty.OBJECTIVE:To explore the strategies and treatment methods of patellofemoral maltracking in total knee arthroplasty.METHODS:Thirty-one patients (32 knee joints) had patellofemoral maltracking in total knee arthroplast. All the patients were female, aged 53-85 years old, averaged in 68.5 years old. The course of the disease was 8-25 years (22.3 years on average). Among all the cases, 28 knees of 27 cases were diagnosed as having osteoarthritis, four knees of four cases were rheumatoid arthritis. The valgus angle was 12°-32° (20°on average) and the Q angle was 13°-23° (16° on average). Correct osteotomy and prosthesis position adjustment, balancing soft tissue of lateral and medial side of the patella or Goldthwait-Roux methods were used for correcting patellofemoral maltracking in total knee arthroplasty.RESULTS AND CONCLUSION:All the patients were followed-up for 12-120 months postoperatively. Average range of motion of the knee joint was (98.2±10.3)°. The Knee Society Score was increased from preoperative 35 points to postoperative 81 points; and the function score of Knee Society Score was increased from preoperative 34 points to postoperative 83 points. After replacement, all incisions were well-healed by first intension, and complications such as necrosis of the skin and wound infection did not occur. Knutsson X-ray on axial position of the patella for 45° inflexion of the knee was found no tilt, subluxation or dislocation of the patella. For correcting patellofemoral maltracking in total knee arthroplasty, adopting stabilized prosthesis, using osteotomy and adjusting the prosthesis position correctly, balancing soft tissue of lateral and medial side of the patella or Goldthwait-Roux can achieve quite satisfactory results.