全膝关节置换术髌骨置换与否的比较
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摘要
目的回顾性分析、比较全膝关节置换术髌骨置换与否的疗效，为临床治疗提供参考。方法回顾研究了2001年1月至2004年12月期间行全膝关节置换术的骨性关节炎患者62例(82膝)，均采用同一类型全膝关节假体。分为髌骨置换和未置换两组，并对两组患者进行随访，膝关节采用HSS评分系统，髌骨采用Feller髌骨评分标准。随访时拍摄膝关节正位片、侧位片和60°髌骨轴位片。结果使用SPSS统计软件进行统计学分析。结果置换组与未置换组术后HGS评分及并发症的发生率无显著性差异(P＞0.05)，两组间髌骨功能评分有显著性差异(P＜0.01)。置换组患者部分功能(上下楼及从椅子上站起)好于未置换组，未置换组术后膝前痛发生率高于置换组，两组间有显著性差异(P＜0.05)，但膝前痛程度多为轻度。结论全膝关节置
换术中选择性进行髌骨置换能改善术后髌骨功能，有利于减少膝前痛的发生，提高病人的满意度。可靠的手术技术不会增加术后髌骨的并发症，但全膝术后髌骨的中、远期结果仍需进一步观察。
Objective To compare retrospectively the clinical outcome of total knee arthroplasty (TKA) with and without patellar replacement. Method From January 2001 to December 2004, 82 knees in 62 patients with TKA were evaluated postoperatively using a questionnaire and physical examination. There were 18 males and 44 females with the age ranging from 45 to 84 years (average 67 years). The primary diagnosis was osteoarthritis in all patients. Fifty-three knees underwent patellar replacement, while 29 knees with reserved patella. The patients were scored using HSS Score system for knees and Feller Score system
for patella. Anteroposterior and lateral views of the knee as well as axial views of the patella were taken in radiography. The data were analyzed using SPSS software. Results Replacement and nonreplacement groups showed no obvious diference in postoperative HSS score and the incidence of patellar complication. The two groups showed statistical significant diferences in scoring on climbing and descending stairs and rising from sitting position, the results suggested that the patellar function score of the replacement group was better than that of the nonreplacemet group. Postoperative anterior knee pain occurred more commonly in the nonreplacement group and showed significant diference (P<0.05) between the two groups, although the pain was mostly mild in degree. Conclusions Patients who underwent patellar resurfacing had superior clinical results in terms of anterior knee pain and patellar function. These findings suggest that, in order to decrease anterior knee pain and improve patellar function postoperatively, selective replacement of the patella during total knee arthroplasty is preferable for patients with osteoarthritis.
换术中选择性进行髌骨置换能改善术后髌骨功能，有利于减少膝前痛的发生，提高病人的满意度。可靠的手术技术不会增加术后髌骨的并发症，但全膝术后髌骨的中、远期结果仍需进一步观察。
Objective To compare retrospectively the clinical outcome of total knee arthroplasty (TKA) with and without patellar replacement. Method From January 2001 to December 2004, 82 knees in 62 patients with TKA were evaluated postoperatively using a questionnaire and physical examination. There were 18 males and 44 females with the age ranging from 45 to 84 years (average 67 years). The primary diagnosis was osteoarthritis in all patients. Fifty-three knees underwent patellar replacement, while 29 knees with reserved patella. The patients were scored using HSS Score system for knees and Feller Score system
for patella. Anteroposterior and lateral views of the knee as well as axial views of the patella were taken in radiography. The data were analyzed using SPSS software. Results Replacement and nonreplacement groups showed no obvious diference in postoperative HSS score and the incidence of patellar complication. The two groups showed statistical significant diferences in scoring on climbing and descending stairs and rising from sitting position, the results suggested that the patellar function score of the replacement group was better than that of the nonreplacemet group. Postoperative anterior knee pain occurred more commonly in the nonreplacement group and showed significant diference (P<0.05) between the two groups, although the pain was mostly mild in degree. Conclusions Patients who underwent patellar resurfacing had superior clinical results in terms of anterior knee pain and patellar function. These findings suggest that, in order to decrease anterior knee pain and improve patellar function postoperatively, selective replacement of the patella during total knee arthroplasty is preferable for patients with osteoarthritis.
引文
1. Kajino A, Yoshino S, Kameyama S, et al. Comparison of the results of bilateral total knee arthroplasty with and without patellar replacement for rheumatoid arthritis. A follow-up note. J Bone Joint Surg Am, 1997, 79: 570-574.
2. Wood DJ, Smith AJ, Collopy D, et al. Patellar resurfacing in total knee arthroplasty: a prospective, randomized trial. J Bone Joint Surg Am, 2002, 84:187-193.
3. Scott WN, Clarke HD. Routine patellar resurfacing: a viable option. Orthopedics, 2003, 26: 684-686.
4. Holt GE and Dennis DA. The role of patellar resurfacing in total knee arthroplasty. Clin Orthop Relat Res, 2003, 416: 76—83.
5. Enis JE, Gardner R, Robledo MA, et al. Comparision of patellar resurfacing versus nonresurfacing in bilateral total knee arthroplasty. Clin Orthop Relat Res, 1990, 260: 38—42.
6. Healy WL, Wasilewski SA, Takei R, et al. Patellofemoral complications following total knee arthroplasty. Correlation with implant design and patient risk factors. J Arthroplasty, 1995, 10: 197—201.
7. Rand JA. The patellofemoral joint in total knee arthroplasty. J Bone Joint Surg Am, 1994, 76: 612-620.
8. Kawakubo M, Matsumoto H, Otani T, et al. Radiographic changes in the patella after total knee arthroplasty without resurfacing the patella. Comparison of osteoarthrosis and rheumatoid arthritis. Bull Hosp Jt Dis, 1997,56:237-244.
9. Ahman R, Asch E, Bloch D, et al, Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum, 1986, 29: 1039- 1049.
10. Insall JN, Ranawat CS, Aglietti P, et al. A comparison of four models of total knee-replacement prostheses. J Bone Joint Surg Am, 1976, 6: 754-765.
11. Feller JA, Bartlett RJ, Lang DM. Patellar resurfacing versus retention in total knee arthroplasty. J Bone Joint Surg Br, 1996, 78: 226—228.
12. Waters TS, Bentley G. Patellar resurfacing in total knee arthroplasty. A Prospective, randomized study. J Bone Joint Surg Am, 2003, 85: 212— 217.
13. Insall J, Salvati E. Patella position in the normal knee joint. Radiology, 1971, 101: 101 — 104.
14. Kujala UM, Friberg O, Aalto T, et al. Lower limb asymmetry and patellofemoral joint incongruence in the etiology of knee exertion injuries in athletes. Int J Sports Med, 1987, 8: 214-220.
15. Pakos EE, Ntzani EE, Trikalinos TA. Patellar resurfacing in total knee arthroplasty. A meta-analysis. J Bone Joint Surg Am, 2005, 87: 1438- 1445.
16. Levitsky KA, Harris WJ, McManus J, et al. Total knee arthroplasty without patellar resurfacing. Clinical outcomes and long-term follow-up evaluation. Clin Orthop Relat Res, 1993, 286: 116-121.
17. Burnett RS, Bourne RB. Indications for patellar resurfacing in total knee arthroplasty. Instr Course lect, 2004, 53: 167- 186.
18. Schroeder-Boersch H, Scheller G, Fischer J, et al. Advantages of patellar resurfacing in total knee arthroplasty. Two-year results of a prospective randomized study. Arch Orthop Trauma Surg, 1998, 117: 73-78.
19. Boyd AD Jr, Ewald FC, Thomas WH, et al. Long-term complications after total knee arthroplasty with or without resurfacing of the patella. J Bone Joint Surg Am, 1993,75:674-681.
20. Barrack RL, Bertot AJ, Wolfe MW, et al. Patellar resurfacing in total knee arthroplasty. A prospective, randomized, double-blind study with five to seven years of follow-up. J Bone Joint Surg Am, 2001, 83: 1376- 1381.
21. Badhe N, Dewnany G, Livesley PJ. Should the patella be replaced in total knee replacement? Int Orthop, 2001,25: 97～99.
22. Marson BM, Tokish JT. The effect of a tourniquet on intraoperative patellofemoral tracking during total knee arthroplasty. J Arthroplasty, 1999, 14: 197～199.
23. Keblish PA, Varma AK, Greenwald AS. Patellar resurfacing or retention in total knee arthroplasty. A prospective study of patients with bilateral replacements. J Bone Joint Surg Br, 1994, 76: 930～937.
24. Hanssen AD. Orthopaedic crossfire—All patellae should be resurfaced during primary total knee arthroplasty: in the affirmative. J Arthroplasty, 2003,18 (3 suppl 1): 31～34.
25．章波，娄思权，张克，等。全膝关节置换术髌骨置换与否的比较。中华骨科杂志，2003，23：78～81
1.Burnett RS, Bourne RB. J Bone Joint Surt Am , 2003; 85(4): 728-745
2. Holt GE, Dennis DA. Clin Orthop, 2003; 416: 76-83
3. Abd-el Wahab M, Szepesi K, Szucs G, et al . Acta Chir Hung, 1998; 37(1-2): 59-66
4. Shih HN, Shih LY, Wong YC, et al. J Bone Joint Surg Am, 2004; 86(5): 935-939
5.Picetti GD 3rd, McGann WA, Welch RB .J Bone Joint Surg Am , 1990; 72(9): 1379-1382
6. Boyd AD Jr, Ewald FC, Thomas WH, et al. J Bone Joint Am , 1993; 75 (5): 674-681
7. Mendes DG, Schwartz 0, Onallah J, et al. Acta Chir Orthop Traumatol Cech, 2003; 70(6) :329-335
8. Levitsky KA, Harris WJ, McManus J, et al. Clin Orthop, 1993; 286: 116-121
9. Waters TS, Bentley G. J Bone Joint Surg Am, 2003; 85-A(2): 212- 217
10.Bourne RB, Rorabeck CH, Vaz M , et al. Glin Orthop, 1995; 321: 156-161
11.Hanssen AD. J Arthroplasty, 2003; 18(3 Suppl 1):31-34
12. MaymanD, Bourne RB, Rorabeck CH, et al. J Arthroplasty, 2003; 18(5): 541-545.
13.BadheN, Dewnany G, Livesley PJ. Int Orthop, 2001; 25(2): 97 - 99.
14. Wood DJ, Smith AJ, Collopy D, et al. J Bone Joint surg Am , 2002; 84(2): 187-193
15. Barrack RL, BertotAJ, Wolfe MW, et al. J Bone Joint Surg Am, 2001; 83-A(9): 1376-1381
16. Tabutin J, Banon F, Catonne Y, et al. Knee Surg Sports Traumatol Arthrosc,2005; 13(7) :534-538
17. Kordelle J, Schleicher I, Kaltschmidt I, et al. Z Orthop Ihre Grenzgeb, 2003; 141 (5) :557-562.
18. Enis JE, Gardner R, Robledo MA, et al. Clin Orthop, 1990; 260: 38-42
19. Shoji H, Yoshino S, Kajino A .J Bone Joint Surg Am , 1989: 71(6): 853-856
20.Lyback Co,Lehto Mu, Hamalainen MM , et aL. Clin Orthop, 2004; 423: 152-156
21. Bourne RB, Burnett RS. Clin Orthop, 2004; 428: 166-169
22. Hsu HC, LuoZp, Rand Ja, et al. J Arthroplasty, 1996; 11: 69- 80
23. Baldwin JL, House CK. J Arthroplasty, 2005; 20(2): 250-257
24.KohJS, Yeo SJ, Lee BP, et al. J Arthroplasty, 2002; 17(1): 56- 61
25. Lie DT, Gloria N, Amis AA, et al. Knee Surg Sports Traumatol Arthrosc,2005; 13(3): 203-208
26. Andriacchi TP, Yoder D, Conley A, et al.J Arthroplasty, 1997; 12(3): 243-249
27.Petersilge WJ, Oishi CS, Kaufman KR, et al.Clin Orthop, 1994; 309: 124-130
28. Conditt MA, Noble PC, Allen B, et al. J Bone Joint Surg Am, 2005; 87(6):1265-1271
29. Shih HN, Shih LY, Wong YC, et al.J Bone Joint Surg Am, 2004 ; 86-A(5) : 935-939
30. Burnett RS, Haydon CM, Rorabeck CH, et al. Clin Orthop Relat Res, 2004 ; (428): 12-25
31. Scott WN, Clarke HD. Orthopedics, 2003; 26(7) :684-686
32. Karnezis IA, Vossinakis IC, Rex C, et al. J Arthroplasty, 2003; 18(8): 993-998
33. Burnett RS, Bourne RB. Instr Course Lect, 2004; 53: 167 - 186
2. Wood DJ, Smith AJ, Collopy D, et al. Patellar resurfacing in total knee arthroplasty: a prospective, randomized trial. J Bone Joint Surg Am, 2002, 84:187-193.
3. Scott WN, Clarke HD. Routine patellar resurfacing: a viable option. Orthopedics, 2003, 26: 684-686.
4. Holt GE and Dennis DA. The role of patellar resurfacing in total knee arthroplasty. Clin Orthop Relat Res, 2003, 416: 76—83.
5. Enis JE, Gardner R, Robledo MA, et al. Comparision of patellar resurfacing versus nonresurfacing in bilateral total knee arthroplasty. Clin Orthop Relat Res, 1990, 260: 38—42.
6. Healy WL, Wasilewski SA, Takei R, et al. Patellofemoral complications following total knee arthroplasty. Correlation with implant design and patient risk factors. J Arthroplasty, 1995, 10: 197—201.
7. Rand JA. The patellofemoral joint in total knee arthroplasty. J Bone Joint Surg Am, 1994, 76: 612-620.
8. Kawakubo M, Matsumoto H, Otani T, et al. Radiographic changes in the patella after total knee arthroplasty without resurfacing the patella. Comparison of osteoarthrosis and rheumatoid arthritis. Bull Hosp Jt Dis, 1997,56:237-244.
9. Ahman R, Asch E, Bloch D, et al, Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum, 1986, 29: 1039- 1049.
10. Insall JN, Ranawat CS, Aglietti P, et al. A comparison of four models of total knee-replacement prostheses. J Bone Joint Surg Am, 1976, 6: 754-765.
11. Feller JA, Bartlett RJ, Lang DM. Patellar resurfacing versus retention in total knee arthroplasty. J Bone Joint Surg Br, 1996, 78: 226—228.
12. Waters TS, Bentley G. Patellar resurfacing in total knee arthroplasty. A Prospective, randomized study. J Bone Joint Surg Am, 2003, 85: 212— 217.
13. Insall J, Salvati E. Patella position in the normal knee joint. Radiology, 1971, 101: 101 — 104.
14. Kujala UM, Friberg O, Aalto T, et al. Lower limb asymmetry and patellofemoral joint incongruence in the etiology of knee exertion injuries in athletes. Int J Sports Med, 1987, 8: 214-220.
15. Pakos EE, Ntzani EE, Trikalinos TA. Patellar resurfacing in total knee arthroplasty. A meta-analysis. J Bone Joint Surg Am, 2005, 87: 1438- 1445.
16. Levitsky KA, Harris WJ, McManus J, et al. Total knee arthroplasty without patellar resurfacing. Clinical outcomes and long-term follow-up evaluation. Clin Orthop Relat Res, 1993, 286: 116-121.
17. Burnett RS, Bourne RB. Indications for patellar resurfacing in total knee arthroplasty. Instr Course lect, 2004, 53: 167- 186.
18. Schroeder-Boersch H, Scheller G, Fischer J, et al. Advantages of patellar resurfacing in total knee arthroplasty. Two-year results of a prospective randomized study. Arch Orthop Trauma Surg, 1998, 117: 73-78.
19. Boyd AD Jr, Ewald FC, Thomas WH, et al. Long-term complications after total knee arthroplasty with or without resurfacing of the patella. J Bone Joint Surg Am, 1993,75:674-681.
20. Barrack RL, Bertot AJ, Wolfe MW, et al. Patellar resurfacing in total knee arthroplasty. A prospective, randomized, double-blind study with five to seven years of follow-up. J Bone Joint Surg Am, 2001, 83: 1376- 1381.
21. Badhe N, Dewnany G, Livesley PJ. Should the patella be replaced in total knee replacement? Int Orthop, 2001,25: 97～99.
22. Marson BM, Tokish JT. The effect of a tourniquet on intraoperative patellofemoral tracking during total knee arthroplasty. J Arthroplasty, 1999, 14: 197～199.
23. Keblish PA, Varma AK, Greenwald AS. Patellar resurfacing or retention in total knee arthroplasty. A prospective study of patients with bilateral replacements. J Bone Joint Surg Br, 1994, 76: 930～937.
24. Hanssen AD. Orthopaedic crossfire—All patellae should be resurfaced during primary total knee arthroplasty: in the affirmative. J Arthroplasty, 2003,18 (3 suppl 1): 31～34.
25．章波，娄思权，张克，等。全膝关节置换术髌骨置换与否的比较。中华骨科杂志，2003，23：78～81
1.Burnett RS, Bourne RB. J Bone Joint Surt Am , 2003; 85(4): 728-745
2. Holt GE, Dennis DA. Clin Orthop, 2003; 416: 76-83
3. Abd-el Wahab M, Szepesi K, Szucs G, et al . Acta Chir Hung, 1998; 37(1-2): 59-66
4. Shih HN, Shih LY, Wong YC, et al. J Bone Joint Surg Am, 2004; 86(5): 935-939
5.Picetti GD 3rd, McGann WA, Welch RB .J Bone Joint Surg Am , 1990; 72(9): 1379-1382
6. Boyd AD Jr, Ewald FC, Thomas WH, et al. J Bone Joint Am , 1993; 75 (5): 674-681
7. Mendes DG, Schwartz 0, Onallah J, et al. Acta Chir Orthop Traumatol Cech, 2003; 70(6) :329-335
8. Levitsky KA, Harris WJ, McManus J, et al. Clin Orthop, 1993; 286: 116-121
9. Waters TS, Bentley G. J Bone Joint Surg Am, 2003; 85-A(2): 212- 217
10.Bourne RB, Rorabeck CH, Vaz M , et al. Glin Orthop, 1995; 321: 156-161
11.Hanssen AD. J Arthroplasty, 2003; 18(3 Suppl 1):31-34
12. MaymanD, Bourne RB, Rorabeck CH, et al. J Arthroplasty, 2003; 18(5): 541-545.
13.BadheN, Dewnany G, Livesley PJ. Int Orthop, 2001; 25(2): 97 - 99.
14. Wood DJ, Smith AJ, Collopy D, et al. J Bone Joint surg Am , 2002; 84(2): 187-193
15. Barrack RL, BertotAJ, Wolfe MW, et al. J Bone Joint Surg Am, 2001; 83-A(9): 1376-1381
16. Tabutin J, Banon F, Catonne Y, et al. Knee Surg Sports Traumatol Arthrosc,2005; 13(7) :534-538
17. Kordelle J, Schleicher I, Kaltschmidt I, et al. Z Orthop Ihre Grenzgeb, 2003; 141 (5) :557-562.
18. Enis JE, Gardner R, Robledo MA, et al. Clin Orthop, 1990; 260: 38-42
19. Shoji H, Yoshino S, Kajino A .J Bone Joint Surg Am , 1989: 71(6): 853-856
20.Lyback Co,Lehto Mu, Hamalainen MM , et aL. Clin Orthop, 2004; 423: 152-156
21. Bourne RB, Burnett RS. Clin Orthop, 2004; 428: 166-169
22. Hsu HC, LuoZp, Rand Ja, et al. J Arthroplasty, 1996; 11: 69- 80
23. Baldwin JL, House CK. J Arthroplasty, 2005; 20(2): 250-257
24.KohJS, Yeo SJ, Lee BP, et al. J Arthroplasty, 2002; 17(1): 56- 61
25. Lie DT, Gloria N, Amis AA, et al. Knee Surg Sports Traumatol Arthrosc,2005; 13(3): 203-208
26. Andriacchi TP, Yoder D, Conley A, et al.J Arthroplasty, 1997; 12(3): 243-249
27.Petersilge WJ, Oishi CS, Kaufman KR, et al.Clin Orthop, 1994; 309: 124-130
28. Conditt MA, Noble PC, Allen B, et al. J Bone Joint Surg Am, 2005; 87(6):1265-1271
29. Shih HN, Shih LY, Wong YC, et al.J Bone Joint Surg Am, 2004 ; 86-A(5) : 935-939
30. Burnett RS, Haydon CM, Rorabeck CH, et al. Clin Orthop Relat Res, 2004 ; (428): 12-25
31. Scott WN, Clarke HD. Orthopedics, 2003; 26(7) :684-686
32. Karnezis IA, Vossinakis IC, Rex C, et al. J Arthroplasty, 2003; 18(8): 993-998
33. Burnett RS, Bourne RB. Instr Course Lect, 2004; 53: 167 - 186