【作者】 叶凯山；

【导师】 吴立东；

【作者基本信息】 浙江大学 ， 外科学， 2007， 硕士

【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。更多还原

【Abstract】 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 systemfor 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.更多还原