摘要
目的比较在全膝关节置换术（TKA）中去除或保留腓肠豆对手术效果的影响。方法自2013年12月至2015年3月期间,对西安市红会医院200例（200膝）膝骨关节炎（OA）Kellgren＆Lawrence分级（K-L分级）Ⅳ级、术前X线片显示均有腓肠豆的患者进行TKA,随机分为腓肠豆去除组和腓肠豆保留组。对比分析两组患者手术时间、术后引流量、视觉模拟评分法（VAS评分）（术后1 d、2 d、3 d、1周、1个月及3个月）、美国特种外科医院（HSS）评分（术后1周、1个月及3个月）以及术后膝关节后外侧疼痛和腓总神经麻痹等指标。在膝外翻病例中,比较两组术中对膝外侧结构的松解程度。计数资料采用卡方检验,计量资料采用Mann-Whitney U进行检验统计。结果术后200例（200膝）OA患者均获得随访,时间3~6个月,平均4个月。两组在手术时间、术后引流量、各时间点VAS评分及HSS评分差异均无统计学意义（P〉0.05）。OA患者TKA后膝关节后外侧疼痛（6例）及腓总神经麻痹（1例）均发生在腓肠豆保留组。膝外翻病例,腓肠豆保留组10例均需松解后外侧关节囊,而腓肠豆去除组13例中只有8例需松解后外侧关节囊,腓肠豆保留组需对后外侧关节囊的松解更广泛（2=4.91,P〈0.05）。结论 OA患者在TKA中去除腓肠豆对术后膝关节功能无明显影响,减少术后膝关节后外侧并发症的发生,对膝外翻病例有助于术中软组织的平衡。
Objective To investigate the impact of fabella removing or remaining on the clinical effects of total knee arthroplasty（ TKA） of osteoarthritis（ OA）. Methods From December,2013 to March 2015,in Xi＇an Honghui Hospital,200 OA patients（ 200 knees） of Kellgren Lawrence（ K-L）grade Ⅳwith fabella visible on the pre-operative X-ray received TKA,who were randomly divided into the fabella-removing group and the fabella-remaining group. The length of surgical time,quantity of postoperative drainage,visual analogue scale（ VAS） score（ 1 d,2 d,3 d,one week,one month and three months after the operation）,hospital for special surgery（ HSS） knee score（ one week,one month and three months after the operation）,posterolateral pain and post-operative palsy of common peroneal nerve were compared. In cases of genu valgum,the release degree of the knee lateral structure was compared between the two groups. Chi-square test was used for qualitative data while Mann-Whitney U test was used for measurement data. Results Two hundreds patients（ 200 knees） were followed up from three to six months,four months in average. No significant difference was found in the length of surgical time,quantity of post-operation drainage,VAS and HSS scores between the two groups（ P〈0. 05）. The posterolateral pain（ six cases） and palsy of common peroneal nerve post-operation（ one case） only happened in the fabella-remaining group. As for the genu valgum cases,the lateral structure release of knee was performed in all the 10 cases in the fabella-remaining group while it was performed in only eight of 13 cases in the fabella-removing group. The knee lateral structure needed more release in the fabella-remaining group（2= 4. 91,P〈0. 05）. Conclusion Removing of fabella does not influence the post-operation knee function,but may reduce the incidence of knee posterolateral complications and be helpful to the soft tissue balance during the operation of the genu valgum.
出处
《中华关节外科杂志（电子版）》
CAS
2016年第3期4-9,共6页
Chinese Journal of Joint Surgery(Electronic Edition)
基金
国家自然科学基金(81201373)
关键词
关节成形术
置换
膝
籽骨
外翻膝
疼痛
手术后
Arthroplasty
replacement
knee
Sesamoid bone
Genu valgum
Pain
postoperative
