目的:双膝关节置换术中随机选择一侧置换髌骨,对侧保留髌骨,对比研究髌骨置换与否对术后临床效果的影响。方法:共入选14例双膝骨关节炎患者,28个膝,均为女性,年龄为53~78岁,平均(66.9±7.8)岁,体重指数为(26.3±1.8)kg/m2。随...目的:双膝关节置换术中随机选择一侧置换髌骨,对侧保留髌骨,对比研究髌骨置换与否对术后临床效果的影响。方法:共入选14例双膝骨关节炎患者,28个膝,均为女性,年龄为53~78岁,平均(66.9±7.8)岁,体重指数为(26.3±1.8)kg/m2。随机分组为拟行左侧或右侧髌骨置换和对侧髌骨保留,术后均获随访,随访时间为3~12个月。随访时记录患者手术前后双膝美国膝关节协会评分(American Knee Society score,KSS)、关节活动度(range of motion,ROM)、术后髌骨倾斜角(patellar tilt angle,PTA)、有无术后膝前痛及髌骨弹响、有无术后膝关节并发症等。结果:术后切口均一期愈合,无感染、松动、髌骨骨折等并发症发生。髌骨置换侧KSS评分由术前的(38.9±22.2)分提高至(92.4±6.7)分,术后较术前KSS增加值为(53.5±20.3)分;保留髌骨侧KSS评分由术前的(38.4±20.5)分提高至(92.1±4.2)分,术后较术前KSS增加为(53.7±21.4)分,两组间KSS评分的增加差异无统计学意义(P=0.98)。髌骨置换侧关节活动度由术前的95.4°±13.5°提高至120.4°±8.9°,术后ROM较术前增加为25.0°±14.5°;保留髌骨侧ROM由术前的92.9°±19.1°增加至120.4°±8.4°,术后较术前ROM增加为27.5°±19.4°,两组间ROM的增加差异也无统计学意义(P=0.70)。术后随访时,患者髌骨置换侧出现膝前痛共3膝(占21.4%),而保留髌骨侧膝前痛共出现2膝(占14.3%),两组间膝前痛的发生率比较差异无统计学意义(P=0.62)。术后髌骨置换侧出现髌骨弹响共3膝(占21.4%),保留髌骨侧3膝(占21.4%),组间比较差异无统计学意义。髌骨置换侧术后PTA为2.6°±2.6°,保留髌骨侧为3.6°±2.9°,两者间差异无统计学意义(P=0.36)。结论:全膝关节置换术中,对于髌骨关节面轻中度破坏的骨关节炎患者,髌骨置换较髌骨保留在术后膝前痛、髌骨弹响的发生率、术后关节功能改善及髌股轨迹等方面并无明显优势。展开更多
It is still controversial whether or not to resurface patella during primary total knee arthroplasty (TKA).One of the reasons may be insensitive measurement tools.We conducted a randomized controlled study to compare ...It is still controversial whether or not to resurface patella during primary total knee arthroplasty (TKA).One of the reasons may be insensitive measurement tools.We conducted a randomized controlled study to compare kinematic and kinetic parameters of resurfacing and nonresurfacing patella with the Vicon gait analysis system.The results show that patient post-operative gait of the two groups improved compared to pre-operative gait.Part of gait parameters,knee flexion at heel-strike,double limb support time and maximum adduction angle appeared to be statistically difference in 3 months,but 12 months later,the gait parameters of the two groups had no significant difference.Therefore,it seems that the final function of knee after TKA is not related whether or not to resurface patella.展开更多
目的观察髌骨不同处理方式在膝关节前内侧骨关节炎单髁置换术(unicompartmental knee arthroplasty,UKA)后的临床疗效。方法选取2016年1月至2019年1月北京大学首钢医院行UKA的患者59例,其中A组(UKA组)43例,B组(UKA+髌骨成形术组)16例,...目的观察髌骨不同处理方式在膝关节前内侧骨关节炎单髁置换术(unicompartmental knee arthroplasty,UKA)后的临床疗效。方法选取2016年1月至2019年1月北京大学首钢医院行UKA的患者59例,其中A组(UKA组)43例,B组(UKA+髌骨成形术组)16例,随访时间8~37个月,平均19.6个月,评价两组在住院时间、手术时间、术中出血量、下地负重时间等方面的差异,观测术前术后髌骨外倾角的变化,采用美国特种外科医院膝关节评分(American hospital for special surgery knee score,HSS)评价膝关节功能,英国骨关节协会满意度评分行患者满意度调查。结果两组在住院时间、术中出血量、下地负重时间方面比较差异无统计学意义(P>0.05),末次随访时两组患者满意度方面差异无统计学意义(P>0.05);A组术前术后髌骨外倾角为(4.55±1.16)°和(4.04±0.98)°,B组由术前(8.21±1.58)°降至(4.51±0.97)°,两组术前术后髌骨外倾角变化差异有统计学意义(P<0.01),但末次随访两组髌骨外倾角变化差异无统计学意义(P>0.05)。结论髌骨成形术组和髌骨未处理组均有创伤小、功能恢复快、患者满意度高的优点,对退变较重的髌股关节行髌骨成形术临床效果满意,膝关节近期功能恢复良好,中远期疗效有待观察。展开更多
Background The long term outcome of patellar resurfacing in Chinese has not been well described.This study evaluated more than 10-year clinical outcomes and survivorship of patellar resurfacing or nonresurfacing in to...Background The long term outcome of patellar resurfacing in Chinese has not been well described.This study evaluated more than 10-year clinical outcomes and survivorship of patellar resurfacing or nonresurfacing in total knee arthroplasty.Methods From January 1993 to December 2002,265 patients accepted total knee arthroplasty in Department of Orthopaedic Surgery,Peking Union Medical College Hospital.Among them,226 patients （246 knees） were successfully followed up,with 176 knees for patellar resurfacing and 70 knees for nonresurfacing.The survivorship of total knee arthroplasty between two groups and the hospital for special surgery knee score （HSS）,patellar score,patellar related complication and radiological results were studied at the latest follow-up.Results The HSS knee score increased from 55.9±12.2 preoperatively to 92.0±10.9 postoperatively for patellar resurfacing group and from 56.6±9.9 to 94.2±11.4 for nonresurfacing group after average 11.4-year follow-up.Patellar score increased from 13.93±2.42 preoperatively to 28.33±2.20 for resurfacing group and from 13.55±2.73 to 27.8±2.37 for nonresurfacing group.There was no statistically significant difference for both HSS score,patellar score between the two groups with higher rate of anterior knee pain for nonresurfacing group.Patellar nonresurfacing had higher lateral subluxation than resurfacing group according to radiological evaluation.Patients with rheumatoid arthritis had 5.5 fold patellar related complication than patients with osteoarthritis.The 10-year survival rate was not statistically significant different between the two groups （P=0.12）.Conclusions There was no significant difference of long-term clinical outcome and survivorship between patellar resurfacing and nonresurfacing.Patellar nonresurfacing can be advisable during primary total knee arthroplasty especially in Chinese patients with osteoarthritis.Selective patellar resurfacing for patients with rheumatoid arthritis can achieve lower patella related complication.展开更多
文摘目的:双膝关节置换术中随机选择一侧置换髌骨,对侧保留髌骨,对比研究髌骨置换与否对术后临床效果的影响。方法:共入选14例双膝骨关节炎患者,28个膝,均为女性,年龄为53~78岁,平均(66.9±7.8)岁,体重指数为(26.3±1.8)kg/m2。随机分组为拟行左侧或右侧髌骨置换和对侧髌骨保留,术后均获随访,随访时间为3~12个月。随访时记录患者手术前后双膝美国膝关节协会评分(American Knee Society score,KSS)、关节活动度(range of motion,ROM)、术后髌骨倾斜角(patellar tilt angle,PTA)、有无术后膝前痛及髌骨弹响、有无术后膝关节并发症等。结果:术后切口均一期愈合,无感染、松动、髌骨骨折等并发症发生。髌骨置换侧KSS评分由术前的(38.9±22.2)分提高至(92.4±6.7)分,术后较术前KSS增加值为(53.5±20.3)分;保留髌骨侧KSS评分由术前的(38.4±20.5)分提高至(92.1±4.2)分,术后较术前KSS增加为(53.7±21.4)分,两组间KSS评分的增加差异无统计学意义(P=0.98)。髌骨置换侧关节活动度由术前的95.4°±13.5°提高至120.4°±8.9°,术后ROM较术前增加为25.0°±14.5°;保留髌骨侧ROM由术前的92.9°±19.1°增加至120.4°±8.4°,术后较术前ROM增加为27.5°±19.4°,两组间ROM的增加差异也无统计学意义(P=0.70)。术后随访时,患者髌骨置换侧出现膝前痛共3膝(占21.4%),而保留髌骨侧膝前痛共出现2膝(占14.3%),两组间膝前痛的发生率比较差异无统计学意义(P=0.62)。术后髌骨置换侧出现髌骨弹响共3膝(占21.4%),保留髌骨侧3膝(占21.4%),组间比较差异无统计学意义。髌骨置换侧术后PTA为2.6°±2.6°,保留髌骨侧为3.6°±2.9°,两者间差异无统计学意义(P=0.36)。结论:全膝关节置换术中,对于髌骨关节面轻中度破坏的骨关节炎患者,髌骨置换较髌骨保留在术后膝前痛、髌骨弹响的发生率、术后关节功能改善及髌股轨迹等方面并无明显优势。
文摘It is still controversial whether or not to resurface patella during primary total knee arthroplasty (TKA).One of the reasons may be insensitive measurement tools.We conducted a randomized controlled study to compare kinematic and kinetic parameters of resurfacing and nonresurfacing patella with the Vicon gait analysis system.The results show that patient post-operative gait of the two groups improved compared to pre-operative gait.Part of gait parameters,knee flexion at heel-strike,double limb support time and maximum adduction angle appeared to be statistically difference in 3 months,but 12 months later,the gait parameters of the two groups had no significant difference.Therefore,it seems that the final function of knee after TKA is not related whether or not to resurface patella.
文摘目的观察髌骨不同处理方式在膝关节前内侧骨关节炎单髁置换术(unicompartmental knee arthroplasty,UKA)后的临床疗效。方法选取2016年1月至2019年1月北京大学首钢医院行UKA的患者59例,其中A组(UKA组)43例,B组(UKA+髌骨成形术组)16例,随访时间8~37个月,平均19.6个月,评价两组在住院时间、手术时间、术中出血量、下地负重时间等方面的差异,观测术前术后髌骨外倾角的变化,采用美国特种外科医院膝关节评分(American hospital for special surgery knee score,HSS)评价膝关节功能,英国骨关节协会满意度评分行患者满意度调查。结果两组在住院时间、术中出血量、下地负重时间方面比较差异无统计学意义(P>0.05),末次随访时两组患者满意度方面差异无统计学意义(P>0.05);A组术前术后髌骨外倾角为(4.55±1.16)°和(4.04±0.98)°,B组由术前(8.21±1.58)°降至(4.51±0.97)°,两组术前术后髌骨外倾角变化差异有统计学意义(P<0.01),但末次随访两组髌骨外倾角变化差异无统计学意义(P>0.05)。结论髌骨成形术组和髌骨未处理组均有创伤小、功能恢复快、患者满意度高的优点,对退变较重的髌股关节行髌骨成形术临床效果满意,膝关节近期功能恢复良好,中远期疗效有待观察。
文摘Background The long term outcome of patellar resurfacing in Chinese has not been well described.This study evaluated more than 10-year clinical outcomes and survivorship of patellar resurfacing or nonresurfacing in total knee arthroplasty.Methods From January 1993 to December 2002,265 patients accepted total knee arthroplasty in Department of Orthopaedic Surgery,Peking Union Medical College Hospital.Among them,226 patients （246 knees） were successfully followed up,with 176 knees for patellar resurfacing and 70 knees for nonresurfacing.The survivorship of total knee arthroplasty between two groups and the hospital for special surgery knee score （HSS）,patellar score,patellar related complication and radiological results were studied at the latest follow-up.Results The HSS knee score increased from 55.9±12.2 preoperatively to 92.0±10.9 postoperatively for patellar resurfacing group and from 56.6±9.9 to 94.2±11.4 for nonresurfacing group after average 11.4-year follow-up.Patellar score increased from 13.93±2.42 preoperatively to 28.33±2.20 for resurfacing group and from 13.55±2.73 to 27.8±2.37 for nonresurfacing group.There was no statistically significant difference for both HSS score,patellar score between the two groups with higher rate of anterior knee pain for nonresurfacing group.Patellar nonresurfacing had higher lateral subluxation than resurfacing group according to radiological evaluation.Patients with rheumatoid arthritis had 5.5 fold patellar related complication than patients with osteoarthritis.The 10-year survival rate was not statistically significant different between the two groups （P=0.12）.Conclusions There was no significant difference of long-term clinical outcome and survivorship between patellar resurfacing and nonresurfacing.Patellar nonresurfacing can be advisable during primary total knee arthroplasty especially in Chinese patients with osteoarthritis.Selective patellar resurfacing for patients with rheumatoid arthritis can achieve lower patella related complication.
