不同髌骨处理方式对人工膝关节置换术疗效水平的影响

刘栋; 邵龙

doi:10.16766/j.cnki.issn.1674-4152.003918

不同髌骨处理方式对人工膝关节置换术疗效水平的影响

doi: 10.16766/j.cnki.issn.1674-4152.003918

刘栋^1, ,,
邵龙²

1.
安吉县第二人民医院骨科，浙江湖州 313307
2.
宁波市第六医院骨科，浙江宁波 315000

基金项目:

浙江省卫生健康科技计划项目 2022RC068

详细信息

通讯作者:
刘栋，E-mail：2002134062@163.com

中图分类号: R684.3 R687.4
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- 文章访问数: 5
- HTML全文浏览量: 1
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2024-10-28
- 网络出版日期: 2025-05-14

Impact of patellar treatment methods on clinical outcomes in artificial knee replacement surgery

LIU Dong^{1
, ,},
SHAO Long²

1.
Department of Orthopedics, Anji County Second People ' s Hospital, Huzhou, Zhejiang 313307, China

摘要

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。
- 膝关节骨性关节炎 /
- 膝关节置换术 /
- 髌骨成形 /
- 髌骨置换 /
- 应力 /
- 膝关节功能 /
- 预后
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.
- Knee osteoarthritis /
- Knee joint replacement surgery /
- Patellar formation /
- Patellar replacement /
- Stress /
- Knee joint function /
- Prognosis

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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)
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，°)	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		0.259^a	0.401^a	0.293^a	0.610^a	0.201^b		0.802^b
P值		0.796	0.691	0.770	0.565	0.654		0.370
注：^a为t值，^b为χ²值。

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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

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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
组别	例数	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±6.25^b	54.97±5.71	81.85±6.47^b	51.46±5.82	85.79±6.48^b
置换组	40	48.17±5.06	84.63±6.68^b	54.23±5.62	87.92±7.18^b	50.92±5.63	92.46±6.91^b
统计量		0.447^a	14.826^c	0.584^a	15.937^c	0.422^a	17.541^c
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。

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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
组别	例数	术前	术后1年	术前	术后1年
成形组	40	52.75±4.98	80.35±6.21^b	16.23±2.48	25.42±2.14^b
置换组	40	53.28±5.16	86.47±6.54^b	16.07±2.35	27.95±2.36^b
统计量		0.467^a	16.284^c	0.296^a	19.358^c
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。

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