全膝关节置换术中滑移髌骨影响术后低位髌骨发生率

目的分析全膝关节置换术中翻转髌骨或者滑移髌骨对术后低位髌骨发生率的影响。 方法纳入广州中医药大学附属新会中医院2017年4月至2019年9月实施的50例全膝关节置换术患者，纳入标准为Kellgren-Lawrence分级为Ⅲ-Ⅳ级的膝关节骨关节炎患者，术前排除低位髌骨。按随机数字表法将其分为两组，观察组采用术中滑移髌骨(n＝25)，对照组采用术中翻转髌骨(n＝25)；并进行12个月的随访，分别比较2组的美国特种外科医院(HSS)膝关节评分、术前术后Insall-Salvati(IS)指数、改良Insall-Salvati(MIS)指数、Blackbume-Peel(BP)指数、Caton-Deschamps(CD)指数及术后低位髌骨发病率。应用卡方检验和t检验比较评分和指数的差异。 结果术前两组HSS膝关节评分差异无统计学意义(t＝0.61，P >0.05)，术后第6、12个月，观察组的HSS功能评分优于对照组(t＝2.64、2.80，均为P <0.05)。术前两组IS指数、MIS指数、CD指数及BP指数差异无统计学意义(t＝0.684、0.87、1.40、0.57，均为P >0.05)；术后观察组IS指数、MIS指数高于对照组(t＝3.004、3.29，均为P <0.05)。术后两组的CD指数、BP指数差异无统计学意义(t ＝－0.06、－0.29，均为P >0.05)。观察组术后低位髌骨发生率低于对照组(χ²＝4.15，P <0.05)。 结论TKA术中滑移髌骨比翻转髌骨术后发生低位髌骨的风险更低，但尚需前瞻性对照研究进一步验证。

Effect of patellar eversion or lateral retraction on incidence of patella baja in total knee arthroplasty

ObjectiveTo analyze the effect of patellar eversion or lateral retraction on the incidence of patella baja in total knee arthroplasty (TKA). MethodsFifty TKA patients of Kellgren-Lawrence grade Ⅲ and Ⅳand without patella baja were enrolled and randomly allocated into two groups in Xinhui Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine from April 2017 to September 2019. Twenty-five cases were included in the control group with eversion patella during operation and 25 cases were included in the observation group with lateral retraction patella. The discharged patients were followed up for one year. The difference of the Hospital for Special Surgery (HSS) scores, Insall Salvati index, modified Insall-Salvati index, Blackbume-Peel index, Caton-Deschamps index and the incidence of patella baja between the two groups were compared. Chi-square test and t test were used for analysis. ResultsThere was no significant difference in the HSS scores between the two groups (t=0.61, P>0.05). After six and 12 months, the HSS score of the observation group was better than that of the control group (t =2.64, 2.80, both P<0.05). Before operation, there was no significant difference in Insall Salvati index, modified Insall-Salvati index, Blackbume-Peel index and Caton-Deschamps index between the two groups (t=0.684, 0.87, 1.40, 0.57 respectively, all P>0.05). One year after discharge, Insall Salvati index and modified Insall-Salvati index in the observation group was higher than that in the control group (t=3.004, 3.29 respectively, P<0.05). There was no significant difference in Blackbume-Peel index and Caton-Deschamps index between the two groups (t=-0.06, -0.29 respectively, P>0.05). The incidence of patella baja in the observation group was less than that in the control group (χ²=4.15, P<0.05). ConclusionThe probability of patella baja in TKA may be lower than in patellar lateral retraction, and use high quality clinical trials to further prove the clinical effects of patellar lateral retraction is necessary.