髌骨置换与否对全膝关节置换术后疗效的影响

目的 探讨膝骨关节炎患者行全膝关节表面置换时髌骨置换与否对术后疗效及并发症发生的影响.方法 对2007年1月至2011年12月之间行人工全膝关节置换术的170例(237膝)骨关节炎患者,按髌骨置换(126膝)和未置换(111膝)分为2组.对术前和末次随访时两组的HSS评分、膝前痛评分、膝关节活动度、最大屈曲度数、屈曲畸形及手术时情况和患者满意度等进行对比分析.结果使用SPSS 17.0统计软件包进行统计学分析.结果 在170例(237膝)OA患者中161例(21 3膝)获得随访,平均随访时间(40.94±8.02)个月,置换组HSS评分由术前的(40.19±8.14)分增加到末次随访时的(87.45±6.00)分(P＜0.05),膝前痛评分由(4.13±1.08)分升高到(19.47±4.04)分(P＜0.05);未置换组HSS评分由(40.00±6.74)分上升到(88.93±4.92)分(P＜0.05),膝前痛评分由(3.58±2.26)分变化到(13.61±3.89)分(P＜0.05);患者满意度置换组为80.91％,未置换组为61.17％(P＜0.05).在HSS评分、膝关节活动度、最大屈曲度数、屈曲畸形等方面两组差异无统计学意义.而在膝前痛评分、患者满意度、手术时间、术中失血量等方面差异有统计学意义.结论 当膝关节骨关节炎患者进行全膝关节置换术时,若术前存在膝关节疼痛严重、患者期望较高、不适合长时间手术,应行髌骨置换.

Influence of Patellar Resurfacing Versus Nonresurfacing in Total Knee Arthro-plasty of Osteoarthritis on Postoperative Effect and Complication

Objective To explore the influence of patellar resurfacing （PR） versus nonresurfacing in total knee arthroplasty （TKA） of osteoarthritis（OA） on postoperative effectiveness and complication. Methods From January lst,2007to December 31st,2011,170 patients （237 knees） with osteoarthritis underuene total knee arthroplasty. The patients received resurfacing （126 knees） or retention of patellar （111 knees）. Evaluation and comparison for scores of knee HSS and anterior knee pain ,range of motion （ROM） of knees ,maximum flection degree ,flexion deformity,infor mations of surgical operation and patients＇satisfaction were done from preoperatively to final followed up postopera- tively. The data were analyzed using SPSS 17. 0 software. Results Out of 170 cases （237 knees）, 161 cases （213 knees） had been followed up for an average of （40.94_＋ 8.02） months. In resurfacing patella group ,knee HSS and an- terior knee pain scores increased from（x-＋s,40.19＋_8.14） and （4.13_4-1.08） preopemtively to（87.45_＋6.00） and （19.47-＋-4.04） postoperatively,which is from（40.00_＋6.74） and（3.58＋_2.26） preoperatively to（88.93--＋4.92） and （13.61---4-_ 3.89） in non-resurfacing patella group. The satisfactory rate of resurfacing patella group was 80.91 ~,and the other was 61.17~, There were significant differences in both groups in anterior knee pain score,patients＇satisfac- tory rate,operation time and intraoperative blood loss ,but no significant difference between the two groups in scores of knee HSS,range of motion （ROM） of knees,maximum flection degree and flexion deformity at the last follow up time point. Conclusion If anterior knee pain is severe ,patients are with high expectations ,operation time is limited or patients＇ blood type is rare ,PR should be determined during TKA treating.