Impact of patellar treatment methods on clinical outcomes in artificial knee replacement surgery
-
摘要:
目的 探讨人工膝关节置换术(TKA)同步实施髌骨置换术和髌骨成形术对于患者术后髌骨力学特征、膝关节功能及并发症的影响。 方法 纳入2021年9月—2023年9月安吉县第二人民医院收治的80例膝关节骨性关节炎患者，采用随机数字表法分为成形组(40例)和置换组(40例)，成形组于TKA过程中同步实施髌骨成形术，置换组于TKA过程中同步实施髌骨置换术。模拟分析患者术后髌骨生物力学特征，评估并比较手术前后膝关节和髌骨功能变化，随访术后1年内并发症发生情况。 结果 置换组术后伸直、屈曲45°和屈曲90°状态下髌骨最大结构应力均低于成形组(P＜0.001)；置换组术后1年美国膝关节协会评分、纽约特种外科医院评分和Lysholm评分[(84.63±6.68)分、(87.92±7.18)分和(92.46±6.91)分]均高于成形组[(78.41±6.25)分、(81.85±6.47)分和(85.79±6.48)分，P＜0.001]；置换组术后1年Kujala评分和Feller评分[(86.47±6.54)分和(27.95±2.36)分]均高于成形组[(80.35±6.21)分和(25.42±2.14)分，P＜0.001]；2组患者术后并发症发生率比较差异无统计学意义(P＞0.05)。 结论 TKA同步实施髌骨成形和髌骨置换均可有效预防并发症，但较髌骨成形，实施髌骨置换更有助于降低患者术后髌骨应力，改善膝关节及髌骨功能水平。 Abstract:Objective This study aimed to evaluate the effects of simultaneous patellar replacement versus patelloplasty during total knee arthroplasty (TKA) on postoperative patellar mechanical characteristics, knee joint function, and complications in patients. Methods A total of 80 patients with knee osteoarthritis and admitted to Anji County Second People ' s Hospital from September 2021 to September 2023 were included. They were randomly divided into a patelloplasty group (40 cases) and a replacement group (40 cases) using a computer random number table method. The patelloplasty group underwent patellar reshaping surgery simultaneously during the TKA process, while the replacement group underwent patellar replacement surgery simultaneously during the TKA process. The biomechanical characteristics of the patient ' s patella after surgery were simulated and analyzed, and the changes in knee joint and patellar function before and after surgery were evaluated. Complications were monitored for one year after surgery. Results The maximum structural stress of the patella in the extended, 45° flexed and 90° flexed states after replacement surgery were significantly lower than those in the patelloplasty group (P < 0.001). The knee society score (KSS) score, hospital for special surgery (HSS) score, and Lysholm score of the replacement group were significantly higher than those of the patelloplasty group at 1 year after surgery [(84.63±6.68) points, (87.92±7.18) points, and (92.46±6.91) points, respectively, P < 0.001]. The Kujala score and Feller score of the replacement group [(86.47±6.54) points and (27.95±2.36) points, respectively] were significantly higher than those of the patelloplasty group [(80.35±6.21) points and (25.42±2.14) points, respectively] at one year after surgery (P < 0.001). The complication rates showed no statistically significant difference in both groups of patients (P>0.05). Conclusion While both patelloplasty and patellar replacement in TKA can effectively prevent complications, patellar replacement is more helpful in reducing postoperative patellar stress and improving knee joint and patellar function. -
表 1 2组KOA患者一般资料比较
Table 1. Comparison of baseline characteristics between two groups of KOA patients
组别 例数 年龄(x ±s，岁) BMI(x ±s) 病程(x ±s，月) 膝关节屈曲度(x ±s，°) 性别(例) 患侧(例) 男性 女性 左侧 右侧 成形组 40 65.43±4.27 22.56±1.92 7.26±1.18 15.16±2.78 20 20 21 19 置换组 40 65.18±4.35 22.39±1.87 7.34±1.26 14.79±2.64 18 22 17 23 统计量 0.259a 0.401a 0.293a 0.610a 0.201b 0.802b P值 0.796 0.691 0.770 0.565 0.654 0.370 注：a为t值，b为χ2值。 
下载: 导出CSV
表 2 2组KOA患者不同膝关节屈曲度状态下髌骨最大结构应力比较(x ±s，MPa)
Table 2. Comparison of maximum structural stress of patella under different knee flexion states in two groups of KOA patients (x ±s, MPa)
组别 例数 伸直状态 屈曲45°状态 屈曲90°状态 成形组 40 8.59±1.17 7.12±0.86 13.46±1.49 置换组 40 7.36±1.08 6.24±0.74 11.83±1.35 t值 4.886 4.906 5.127 P值 ＜0.001 ＜0.001 ＜0.001
下载: 导出CSV
表 3 2组KOA患者手术前后膝关节功能评分比较(x ±s，分)
Table 3. Comparison of knee function scores before and after operation between the two groups of KOA patients (x ±s, score)
组别 例数 KSS评分 HSS评分 Lysholm评分 术前 术后1年 术前 术后1年 术前 术后1年 成形组 40 47.65±5.34 78.41±6.25b 54.97±5.71 81.85±6.47b 51.46±5.82 85.79±6.48b 置换组 40 48.17±5.06 84.63±6.68b 54.23±5.62 87.92±7.18b 50.92±5.63 92.46±6.91b 统计量 0.447a 14.826c 0.584a 15.937c 0.422a 17.541c P值 0.656 ＜0.001 0.561 ＜0.001 0.674 ＜0.001 注：a为t值，c为F值；与同组术前比较，bP＜0.05。
下载: 导出CSV
表 4 2组KOA患者手术前后髌骨功能评分情况比较(x ±s，分)
Table 4. Comparison of patellar function scores before and after operation between the two groups of KOA patients (x ±s, scores)
组别 例数 Kujala评分 Feller评分 术前 术后1年 术前 术后1年 成形组 40 52.75±4.98 80.35±6.21b 16.23±2.48 25.42±2.14b 置换组 40 53.28±5.16 86.47±6.54b 16.07±2.35 27.95±2.36b 统计量 0.467a 16.284c 0.296a 19.358c P值 0.642 ＜0.001 0.768 ＜0.001 注：a为t值，c为F值；与同组术前比较，bP＜0.05。
下载: 导出CSV
-
[1] 时中洋, 傅宏, 马文辉, 等. 计算机辅助导航下全膝关节置换术治疗晚期膝骨性关节炎的疗效[J]. 浙江临床医学, 2023, 25(8): 1161-1163.SHI Z Y, FU H, MA W H, et al. Total knee arthroplasty with computer-assisted navigation for the treatment of advanced knee osteoarthritis[J]. Zhejiang Clinical Medical Journal, 2023, 25(8): 1161-1163. [2] BURGER J A, DOOLEY M S, KLEEBLAD L J, et al. What is the impact of patellofemoral joint degeneration and malalignment on patient-reported outcomes after lateral unicompartmental knee arthroplasty?[J]. Bone Joint J, 2020, 102-B(6): 727-735. doi: 10.1302/0301-620X.102B6.BJJ-2019-1429.R1 [3] 田文明, 耿登峰, 周恩昌, 等. 个体化股骨后髁旋转测量截骨在膝关节骨性关节炎全膝关节置换术中的应用效果[J]. 临床误诊误治, 2023, 36(2): 90-93.TIAN W M, GENG D F, ZHOU E C, et al. Effect of individualized rotational measurement of posterior femoral condyle osteotomy in patients undergoing total knee arthroplasty[J]. Clinical Misdiagnosis & Mistherapy, 2023, 36(2): 90-93. [4] 胡秀年, 廖发科, 廖元军, 等. 经股内侧肌下入路与髌旁入路对初次全膝关节置换术后膝关节早期功能锻炼的影响[J]. 中国骨与关节损伤杂志, 2023, 38(12): 1248-1252. doi: 10.7531/j.issn.1672-9935.2023.12.004HU X N, LIAO F K, LIAO Y J, et al. Influence of subvastus and parapatellar approaches on early functional exercise of knee joint after primary total knee arthroplasty[J]. Chinese Journal of Bone and Joint Injury, 2023, 38(12): 1248-1252. doi: 10.7531/j.issn.1672-9935.2023.12.004 [5] 王帝, 韩立业, 张爱民, 等. 不同截骨技术在老年全膝关节置换术中的效果对比研究[J]. 中国临床医生杂志, 2020, 48(11): 1343-1346. doi: 10.3969/j.issn.2095-8552.2020.11.026WANG D, HAN L Y, ZHANG A M, et al. Comparative study on the effect of different osteotomy techniques in total knee arthroplasty in the elderly[J]. Chinese Journal For Clinicians, 2020, 48(11): 1343-1346. doi: 10.3969/j.issn.2095-8552.2020.11.026 [6] 周皓, 沈凯, 王锦文, 等. 术前髌骨倾斜角对全膝关节置换术后疗效的影响[J]. 中华骨科杂志, 2024, 44(9): 594-600. doi: 10.3760/cma.j.cn121113-20231202-00351ZHOU H, SHEN K, WANG J W, et al. The effect of preoperative patellar tilt angle on postoperative outcome of total knee arthroplasty[J]. Chinese Journal of Orthopaedics, 2024, 44(9): 594-600. doi: 10.3760/cma.j.cn121113-20231202-00351 [7] 中华医学会骨科学分会关节外科学组, 中国医师协会骨科医师分会骨关节炎学组, 湘雅医院国家老年疾病临床医学研究中心, 等. 中国骨关节炎诊疗指南(2021年版)[J]. 中华骨科杂志, 2021, 41(18): 1291-1314. doi: 10.3760/cma.j.cn121113-20210624-00424The Joint Surgery Branch of the Chinese Orthopaedic Association; The Subspecialty Group of Osteoarthritis, Chinese Association of Orthopaedic Surgeons; The National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), et al. Chinese guideline for diagnosis and treatment of osteoarthritis(2021 edition)[J]. Chinese Journal of Orthopaedics, 2021, 41(18): 1291-1314. doi: 10.3760/cma.j.cn121113-20210624-00424 [8] 沈小桐, 涂小华. 膝关节置换术后康复影响因素的研究进展[J]. 现代医药卫生, 2021, 37(7): 1145-1149. doi: 10.3969/j.issn.1009-5519.2021.07.020SHEN X T, TU X H. Research progress on influencing factors of rehabilitation after knee arthroplasty[J]. Journal of Modern Medicine & Health, 2021, 37(7): 1145-1149. doi: 10.3969/j.issn.1009-5519.2021.07.020 [9] 张佳佳, 张战峰, 石玉君, 等. 质控管理小组对髋膝关节置换术患者的围术期指标及安全性的影响[J]. 海南医学, 2024, 35(6): 905-909. doi: 10.3969/j.issn.1003-6350.2024.06.029ZHANG J J, ZHANG Z F, SHI Y J, et al. Effect of quality control management team on perioperative indexes and safety of patients undergoing hip and knee replacement[J]. Hainan Medical Journal, 2024, 35(6): 905-909. doi: 10.3969/j.issn.1003-6350.2024.06.029 [10] 周琳琳, 胡敏, 司文腾. 膝关节置换患者焦虑现状以及对膝关节康复功能的影响研究[J]. 医药论坛杂志, 2024, 45(6): 633-636, 640.ZHOU L L, HU M, SI W T. Anxiety status of knee replacement patients and its impact on knee rehabilitation function[J]. Journal of Medical Forum, 2024, 45(6): 633-636, 640. [11] AÏT-SI-SELMI T, MARIE-HARDY L, O'LOUGHLIN P F, et al. Patellar facet ratio affects knee pain, stair climbing and stair descent after TKA without patellar resurfacing[J]. Knee Surg Sports Traumatol Arthrosc, 2020, 28(12): 3796-3804. doi: 10.1007/s00167-020-05868-y [12] 卢文海, 孙少松, 史思峰. UKA术中髌骨周围去神经化治疗累及髌股关节膝关节骨性关节炎的近期疗效[J]. 川北医学院学报, 2023, 38(12): 1710-1713. doi: 10.3969/j.issn.1005-3697.2023.12.029LU W H, SUN S S, SHI S F. Short-term efficacy of peripatellar denervation during UKA in the treatment of knee osteoarthritis involving patellofemoral joint[J]. Journal of North Sichuan Medical College, 2023, 38(12): 1710-1713. doi: 10.3969/j.issn.1005-3697.2023.12.029 [13] 王昭瑞, 李兴彬, 王邦, 等. 膝关节单髁置换术固定平台与活动平台假体对髌骨高度影像学变化的研究[J]. 中国骨与关节损伤杂志, 2024, 39(5): 485-491.WANG S R, LI X B, WANG B, et al. Radiographic changes of patellar height with fixed-bearing versus mobile-bearing prosthesis in unicompartmental knee arthroplasty[J]. Chinese Journal of Bone and Joint Injury, 2024, 39(5): 485-491. [14] 吕鹏飞, 关振鹏. 髌骨处理技术在全膝关节置换术中的研究进展[J]. 中国骨与关节杂志, 2019, 8(12): 958-961. doi: 10.3969/j.issn.2095-252X.2019.12.015LYU P F, GUAN Z P. Research progress on the patella management in total knee arthroplasty[J]. Chinese Journal of Bone and Joint, 2019, 8(12): 958-961. doi: 10.3969/j.issn.2095-252X.2019.12.015 [15] 庞呈祥, 王一迪, 王亚楠, 等. 行髌骨置换的全膝关节置换术后髌骨倾斜角对患者早期疗效影响[J]. 中国中医骨伤科杂志, 2024, 32(8): 1-6.PANG C X, WANG Y D, WANG Y N, et al. Efficacy of patellar tilt angle on early patient outcomes after total knee arthroplasty with patellar replacement[J]. Chinese Journal of Traditional Medical Traumatology & Orthopedics, 2024, 32(8): 1-6. [16] RAAIJ T M, MEIJ E V, VRIES A J, et al. Patellar resurfacing does not improve clinical outcome in patients with symptomatic tricompartmental knee osteoarthritis. An RCT study of 40 patients receiving primary cruciate retaining total knee arthroplasty[J]. J Knee Surg, 2021, 34(14): 1503-1509. doi: 10.1055/s-0040-1710369 [17] HA C Z, WANG B X, LI W, et al. Resurfacing versus not-resurfacing the patella in one-stage bilateral total knee arthroplasty: a prospective randomized clinical trial[J]. Int Orthop, 2019, 43(11): 2519-2527. doi: 10.1007/s00264-019-04361-7 [18] 宋志勇, 蒋捷, 陈炳灿. 膝关节置换术中髌骨成形与髌骨置换治疗膝关节骨关节炎对患者膝关节及髌骨功能的影响[J]. 临床医学工程, 2024, 31(7): 807-808.SONG Z Y, JIANG J, CHENG B C, et al. Impact of patelloplasty and patellar replacement in the treatment of knee osteoarthritis during knee arthroplasty on patients' knee joint and patella function[J]. Clinical Medicine & Engineering, 2024, 31(7): 807-808. [19] MIGLIORINI F, ESCHWEILER J, NIEWIERA M, et al. Better outcomes with patellar resurfacing during primary total knee arthroplasty: a meta-analysis study[J]. Arch Orthop Trauma Surg, 2019, 139(10): 1445-1454. doi: 10.1007/s00402-019-03246-z [20] 贾钧策, 翁习生. 初次人工全膝关节置换术中不同髌骨处理方式的远期疗效[J]. 中国修复重建外科杂志, 2022, 36(12): 1479-1484.JIAN J C, WENG X S. Long-term effectiveness of different patellar treatments in primary total knee arthroplasty[J]. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(12): 1479-1484. [21] 罗毅, 孙卫平, 李中军, 等. 初次全膝关节置换是否髌骨表面置换的比较[J]. 中国矫形外科杂志, 2024, 32(14): 1322-1325.LUO Y, SUN W P, LI Z J, et al. Primary total knee arthroplasty with or without patellar resurfacing[J]. Orthopedic Journal of China, 2024, 32(14): 1322-1325. [22] 周陶勇, 杨永盛, 鲁宁, 等. 膝关节骨性关节炎轻症患者膝关节三维有限元建模及力学分析[J]. 中国医学物理学杂志, 2024, 41(3): 382-388.ZHOU T Y, YANG Y S, LU N, et al. Three-dimensional finite element modeling and mechanical analysis of knee joint in patients with mild knee osteoarthritis[J]. Chinese Journal of Medical Physics, 2024, 41(3): 382-388. -
点击查看大图
表(4)
计量
- 文章访问数: 3
- HTML全文浏览量: 0
- PDF下载量: 0
- 被引次数: 0
