不置换髌骨的全膝关节置换：膝关节功能及膝前痛发生率评估

摘要

背景：尽管髌骨并发症发生率在全膝关节置换中逐渐下降，但是否需要置换髌骨一直存在争议。目的：观察全膝关节置换过程中不置换髌骨的术后关节功能评分及膝前痛发生率，为临床置换方案的制定提供参考。方法：选取接受全膝关节置换的患者151例193膝，所有患者均给予髌骨成形但不置换髌骨。采用西大略湖和麦克马斯特大学骨关节炎指数(WOMAC)和美国特种外科医院评分在患者置换前和置换后6，12个月进行评估，对比全膝关节置换前后膝关节功能的变化，同时对比置换前后膝前痛的发生率和目测类比评分。结果与结论：全膝关节置换后6，12个月，患者的WOMAC骨关节炎指数显著低于置换前，而美国特种外科医院评分则显著高于置换前，差异均有显著性意义(P <0.05)。全膝关节置换后12个月，患者膝前痛的发生率为11.3%，显著低于置换前94.7%(P<0.05)；置换后12个月的目测类比评分也显著低于置换前，差异有显著性意义(P<0.05)。提示全膝关节置换过程中行髌骨成形而不置换髌骨能够有效改善膝骨关节炎或者类风湿关节炎患者的膝关节功能，缓解膝前痛的症状，置换后短期疗效较可靠，但中远期疗效需进一步观察。%BACKGROUND:The incidence of patel ar complications is decreasing, however, the necessity of patel ar replacement remains unclear. OBJECTIVE:To investigate the incidence rate of anterior knee pain and postoperative pain score in total knee arthroplasty without the patel ar replacement and to provide a reference for the formulation of clinical operation scheme. METHODS:151 patients with 193 knees receiving total knee arthroplasty were involved in this study. Al the patients were treated with patel ar forming but not resurfacing of the patel a. The Western Ontario and McMaster University (WOMAC) Osteoarthritis Index and America Hospital for Special Surgery (HSS) score were used to evaluate patients before surgery and at 6 and 12 months after surgery. The function of knee joint, the incidence rate of anterior knee pain and visual analogous scale score before and after operation were compared. RESULTS AND CONCLUSION:After 6 and 12 months of total knee arthroplasty, WOMAC osteoarthritis index was significantly lower and HSS score was significantly higher than those before surgery (P<0.05). At 12 months post-operation, the incidence rate of anterior knee pain was 11.3%, which was significantly lower than the preoperative rate (94.5%) (P<0.05). At 12 months post-surgery, visual analogous scale scores were also significantly lower than the preoperative score (P<0.05). Total knee replacement without resurfacing of the patel a can effectively improve knee joint function in knee osteoarthritis or rheumatoid arthritis patients, ameliorate the symptoms of anterior knee pain, has a good clinical effect within short term post-operation. The middle-and long-term effects need further exploration.