全膝关节置换术使用不可吸收线加强缝合内侧关节囊对术后髌骨倾斜的影响
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摘要
目的:分析比较在初次全膝关节置换术(TKA)中使用不可吸收线加强缝合髌骨内侧关节囊对术后髌骨倾斜的影响。方法:本研究回顾性分析了从2014年12月至2017年9月期间在我院治疗的22例随访资料齐全的初次全膝关节置换的患者资料,根据术中是否使用不可吸收线加强缝合内侧关节囊,将患者分为普通组和加强缝合组,普通组12例,加强缝合组10例。通过患者手术前后的X线片测量髋膝踝角(HKA)、Insall-Salviti指数(ISR)、髌骨倾斜角(PTA),采用美国膝关节协会(KSS)评分评价患者手术前后膝关节功能。比较两组患者手术前以及术后1个月、术后末次随访时HKA、ISR、PTA以及KSS评分等指标。结果:普通组患者KSS评分、ROM、HKA,术后有明显改善(P<0.05),其中ROM在术后末次随访时改善更为显著;PTA术后较术前增大(P<0.05);ISR手术前后无明显差异(P>0.05)。加强缝合组患者KSS评分、ROM,在术后1个月时无明显提升(P>0.05),但在术后末次随访时提升明显(P<0.05)。PTA术后较术前减小(P<0.05)。HKA、ISR手术前后无明显差异(P>0.05)。无论在术后1个月还是术后末次随访时,加强缝合组PTA都小于普通组(P<0.05)。结论:在使用内侧髌旁入路的TKA中,使用不可吸收线加强缝合内侧关节囊可在一定程度上减小术后髌骨的倾斜,提升髌骨的稳定性,值得临床推广应用。
Objective: To analyze the effect of the use of non-absorbable suture to strengthen the medial joint capsule on the stability of the patellaafter primary total knee arthroplasty(TKA). Methods: This retrospective study analyzed the data of 22 patients who underwent primary total knee arthroplasty for end-stage knee osteoarthritis from December 2014 to September 2017. The data were analyzed retrospectively according to whether intraoperative use of non-absorbable suture to strengthen the sutured medial joint. The patients were divided into group A and group B. The hipknee ankle angle(HKA), insall-Salviti index(ISR), patella tilt angle(PTA)were measured by the X-ray radiographs before and after operation. All included patients were assessed the function of knee by using the Knee Surgery Society(KSS)scores. Comparingthe data of two groups of patients, including HKA, ISR, PTA and KSS in the X-ray before and after the operation were followed up for 1 month and last follow-up. Results: The KSS, ROM, and HKA were significantly improved in the group A(P <0.05). ROM was improved more significantly at the last follow-up postoperatively. However, ISR had no significant difference between before and after the operation(P>0.05), PTA had significant enhance postoperatively. In group B, the KSS and ROM were not significantly improved at 1 month postoperatively(P>0.05), but were significantly improved at the last follow-up postoperatively(P<0.05). PTA was significantly reduced after the operation(P<0.05). HKA and ISR were no significant difference between before and after the operation(P<0.05). In postoperative stage, the PTA in the group B was smaller than that in the group A(P<0.05). Conclusion: In TKAs using medial patellar approach, the use of non-absorbable sutures to strengthen the the medial joint capsule can reduce postoperative patella tilt and enhance the stability of the patella, which is worthy ofclinical application.
Objective: To analyze the effect of the use of non-absorbable suture to strengthen the medial joint capsule on the stability of the patellaafter primary total knee arthroplasty(TKA). Methods: This retrospective study analyzed the data of 22 patients who underwent primary total knee arthroplasty for end-stage knee osteoarthritis from December 2014 to September 2017. The data were analyzed retrospectively according to whether intraoperative use of non-absorbable suture to strengthen the sutured medial joint. The patients were divided into group A and group B. The hipknee ankle angle(HKA), insall-Salviti index(ISR), patella tilt angle(PTA)were measured by the X-ray radiographs before and after operation. All included patients were assessed the function of knee by using the Knee Surgery Society(KSS)scores. Comparingthe data of two groups of patients, including HKA, ISR, PTA and KSS in the X-ray before and after the operation were followed up for 1 month and last follow-up. Results: The KSS, ROM, and HKA were significantly improved in the group A(P <0.05). ROM was improved more significantly at the last follow-up postoperatively. However, ISR had no significant difference between before and after the operation(P>0.05), PTA had significant enhance postoperatively. In group B, the KSS and ROM were not significantly improved at 1 month postoperatively(P>0.05), but were significantly improved at the last follow-up postoperatively(P<0.05). PTA was significantly reduced after the operation(P<0.05). HKA and ISR were no significant difference between before and after the operation(P<0.05). In postoperative stage, the PTA in the group B was smaller than that in the group A(P<0.05). Conclusion: In TKAs using medial patellar approach, the use of non-absorbable sutures to strengthen the the medial joint capsule can reduce postoperative patella tilt and enhance the stability of the patella, which is worthy ofclinical application.
引文
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[11]Aydogdu S,Zileli B,Cullu E,et al.Increased turn/amplitude parameters following subvastus approach in total knee arthroplasty[J].Knee Surgery Sports Traumatology Arthroscopy Official Journal of the Esska,2014,22(7):1632
[12]Vaishya R,Vijay V,Demesugh DM,et al.Surgical approaches for total knee arthroplasty[J].J Clin Orthop Trauma,2016,7(2):71-79
[13]梁兴森,余正红,李义凯,等.髌内外侧稳定结构与髌股关节稳定性实验研究[J].中国骨伤,2017,30(4):364-367
[14]Chan VW,Chan PK,Chiu KY,et al.Does Barbed Suture Lower Cost and Improve Outcome in Total Knee Arthroplasty?A Randomized Controlled Trial[J].The Journal of Arthroplasty,2017,32(5):1474-1477
[15]Sasaki T,Yagi T.Subluxation of the patella[J].International Orthopaedics,1986,10(2):115-120
[16]Sharma A,Grieco TF,Zingde SM,et al.In Vivo Three-Dimensional Patellar Mechanics:Normal Knees Compared with Domed and Anatomic Patellar Components[J].The Journal of Bone and Joint Surgery,2017,99(5):e18
[17]Kita K,Horibe S,Toritsuka Y,et al.Effects of medial patellofemoral ligament reconstruction on patellar tracking[J].Knee Surgery Sports Traumatology Arthroscopy Official Journal of the Esska,2012,20(5):829-837
[18]Tanaka MJ,Elias JJ,Williams AA,et al.Characterization of patellar maltracking using dynamic kinematic CT imaging in patients with patellar instability[J].Knee Surgery Sports Traumatology Arthroscopy,2016,24(11):1-8
[19]Biyani R,Elias JJ,Saranathan A,et al.Anatomical factors influencing patellar tracking in the unstable patellofemoral joint[J].Knee Surg Sports TraumatolArthrosc,2014,22(10):2334-2341
[20]Lin F,Makhsous M,Chang AH,et al.In vivo and noninvasive six degrees of freedom patellar tracking during voluntary knee movement[J].Clinical Biomechanics,2003,18(5):401-409
[21]Lin F,Wilson NM,Press JM,et al.In vivo patellar tracking induced by individual quadriceps components in individuals with patellofemoralpain[J].Journal of Biomechanics,2010,43(2):235-241
[2]Westerman RW,Bhangoo NS,James P.When and How Is Patella Tracking Best Assessed in Total Knee Arthroplasty Surgery?[J]Journal of Knee Surgery,2015,29(04):337-340
[3]Keshmiri A,Dotzauer F,Baier C,et al.Stability of capsule closure and postoperative anterior knee pain after medial parapatellar approach in TKA[J].Archives of Orthopaedic&Trauma Surgery,2017,137(11)1-6
[4]Lamotte A,Neri T,Kawaye A,et al.Medial patellofemoral ligament reconstruction for patellar instability following total knee arthroplasty:A review of 6 cases[J].Orthopaedics&Traumatology Surgery&Research,2016,102(5):607-610
[5]Schorn D,Yangstrathoff S,Gosheger G,et al.Long-term outcomes after combined arthroscopic medial reefing and lateral release in patients with recurrent patellar instability a retrospective analysis[J].Bmc Musculoskeletal Disorders,2017,18(1):277
[6]Hochberg MC,Altman RD,Brandt KD,et al.Guidelines for the medical management of osteoarthritis.Part II.Osteoarthritis of the knee.American College of Rheumatology[J].Arthritis&Rheumatism,1995,38(11):1541-1546
[7]Bedi A,Maak T,Musahl V,et al.Effect of Tunnel Position and Graft Size in Single-Bundle Anterior Cruciate Ligament Reconstruction:An Evaluation of Time-Zero Knee Stability[J].Arthroscopy-the Journal of Arthroscopic&Related Surgery,2011,27(11):1543-1551
[8]Sharma V1,Tsailas PG,Maheshwari AV,et al.Does patellar eversion in total knee arthroplasty cause patella baja?[J].Clin Orthop Relat Res,2008,466(11):2763-2768
[9]Nodzo SR,Kasparek M,Rueckl K,et al.The location of the medial parapatellar arthrotomy influences intraoperative patella tracking[J].Knee Surgery Sports Traumatology Arthroscopy,2018,26(6):1786-1791
[10]周超,彭玮,司志平.全膝关节置换不同入路对伸膝装置影响的比较[J].中国组织工程研究,2014,18(9):1337-1342
[11]Aydogdu S,Zileli B,Cullu E,et al.Increased turn/amplitude parameters following subvastus approach in total knee arthroplasty[J].Knee Surgery Sports Traumatology Arthroscopy Official Journal of the Esska,2014,22(7):1632
[12]Vaishya R,Vijay V,Demesugh DM,et al.Surgical approaches for total knee arthroplasty[J].J Clin Orthop Trauma,2016,7(2):71-79
[13]梁兴森,余正红,李义凯,等.髌内外侧稳定结构与髌股关节稳定性实验研究[J].中国骨伤,2017,30(4):364-367
[14]Chan VW,Chan PK,Chiu KY,et al.Does Barbed Suture Lower Cost and Improve Outcome in Total Knee Arthroplasty?A Randomized Controlled Trial[J].The Journal of Arthroplasty,2017,32(5):1474-1477
[15]Sasaki T,Yagi T.Subluxation of the patella[J].International Orthopaedics,1986,10(2):115-120
[16]Sharma A,Grieco TF,Zingde SM,et al.In Vivo Three-Dimensional Patellar Mechanics:Normal Knees Compared with Domed and Anatomic Patellar Components[J].The Journal of Bone and Joint Surgery,2017,99(5):e18
[17]Kita K,Horibe S,Toritsuka Y,et al.Effects of medial patellofemoral ligament reconstruction on patellar tracking[J].Knee Surgery Sports Traumatology Arthroscopy Official Journal of the Esska,2012,20(5):829-837
[18]Tanaka MJ,Elias JJ,Williams AA,et al.Characterization of patellar maltracking using dynamic kinematic CT imaging in patients with patellar instability[J].Knee Surgery Sports Traumatology Arthroscopy,2016,24(11):1-8
[19]Biyani R,Elias JJ,Saranathan A,et al.Anatomical factors influencing patellar tracking in the unstable patellofemoral joint[J].Knee Surg Sports TraumatolArthrosc,2014,22(10):2334-2341
[20]Lin F,Makhsous M,Chang AH,et al.In vivo and noninvasive six degrees of freedom patellar tracking during voluntary knee movement[J].Clinical Biomechanics,2003,18(5):401-409
[21]Lin F,Wilson NM,Press JM,et al.In vivo patellar tracking induced by individual quadriceps components in individuals with patellofemoralpain[J].Journal of Biomechanics,2010,43(2):235-241