摘要
背景:术后低位髌骨是全膝关节置换术后常见并发症,会引起膝前区疼痛、关节活动度受限、关节僵硬,假体撞击与磨损,影响术后疗效及患者满意度。目的:对需行全膝关节置换术的患者进行影像学测量,发现术前低位髌骨的患者,调整关节线改善其髌骨高度,并研究术后疗效。方法:2017年1月至2017年12月连续纳入行初次全膝关节置换术患者532例,通过影像学检查,测量并计算Blakburne-Peel指数(BPI),对术前低位髌骨的患者下调关节线,调整髌骨高度。计算手术前后低位髌骨发生率,评估手术前后HSS评分、VAS评分及关节活动度,分析临床疗效。结果:术前低位髌骨的患者共17例,行关节线调整后,12例患者术后髌骨高度正常(术前BPI:0.52±0.02;术后BPI:0.58±0.02),5例(29.4%)患者术后仍为低位髌骨(术前BPI:0.50±0.03,术后BPI:0.51±0.02)。术前非低位髌骨患者,未行关节线调整,术后低位髌骨的发生率为17.1%(术前BPI:0.76±0.12,术后BPI:0.51±0.02)。术后髌骨高度正常的患者比术后低位髌骨患者有更好的关节活动度、更高的HSS评分及更低的VAS评分。结论:术前行影像学测量有助于术前发现低位髌骨患者,关节线下调可有效治疗术前低位髌骨,并可获得良好的术后疗效。术前有低位髌骨的患者经关节线调整为正常后,其临床效果与手术前后髌骨高度均正常的患者相似。
Background: Postoperative patella baja is a common complication after total knee arthroplasty(TKA), causing anterior knee pain, range of motion reduced, knee stiff, prosthesis impingement and loose, and impacting clinical effect and patient’s satisfaction. Objective: To investigate the effect of joint line adjustment on patella baja and its post-operative efficacy. Methods: From January to December 2017, 532 consecutive patients receiving primary TKA were included in this study. Radiographic measurements were performed in pre-operation and post-operation, and Blakburne-Peel(BPI) ratio was calculated.For patients with patella baja, we adjusted the joint line to get a suitable patella height. The incidences of pre-operative and post-operative patella baja were calculated. Hospital for special surgery(HSS), visual analogue scale(VAS) and range of motion(ROM) were measured to evaluate the clinical effects. Results: There were 17 patients with pre-operative patella baja. After the joint line adjustment, 12 of them got a normal patella height(pre-BPI: 0.52±0.02;post-BPI: 0.58±0.02). 5 of them(29.4%) still suffered patella baja(pre-BPI: 0.50±0.03;post-BPI: 0.51±0.02). Among the patients with the normal patella height, 17.1% of them got post-operative patella baja(pre-BPI: 0.76±0.12;post-BPI: 0.51±0.02). The patients with the normal patella height got a higher ROM, better HSS and lower VAS score than the patients with patella baja after TKA. Conclusions:Radiographic measurements before operation will help to find out those with pre-operative patella baja. Adjusting the joint line will restore their patella height as well as get good clinical effects. The patients who get the normal patella height after receiving a joint line adjustment have as good clinical effects as the patients with the normal patella height both before and after operation.
作者
邹春雨
米豫飞
赵晓非
王战朝
ZOU Chunyu;MI Yufei;ZHAO Xiaofei;WANG Zhanchao(Research and Treatment Center for Knee Diseases,Luoyang Zhenggu Hospital,Luoyang 471000,Henan,China)
出处
《中华骨与关节外科杂志》
2020年第4期290-294,共5页
Chinese Journal of Bone and Joint Surgery
关键词
低位髌骨
关节线调整
全膝关节置换术
术后疗效
Patella Baja
Joint Line Adjustment
Total Knee Arthroplasty
Postoperative Efficacy
