切换至 "中华医学电子期刊资源库"
高级检索
中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (02) : 168 -172,241. doi: 10.3877/cma.j.issn.1674-134X.2019.02.007

所属专题： 文献；

临床论著

髌骨缩小联合外侧支持带松解对膝关节置换术的疗效影响
赵传喜1, 曾明珠1,†(), 曾子全1, 刘文刚1   
  1. 1. 510095　广州，广东省第二中医院骨一科
  • 收稿日期:2019-01-29 出版日期:2019-04-01
  • 通信作者: 曾明珠

Analysis of effect of patellar reduction combined with lateral patellar retinaculum release after total knee arthroplasty

Chuanxi Zhao1, Mingzhu Zeng1,†(), Ziquan Zeng1, Wengang Liu1   

  1. 1. Department of Orthopedics, Guangdong Second Hospital of Traditional Chinese Medicine, Guangzhou 510095, China
  • Received:2019-01-29 Published:2019-04-01
  • Corresponding author: Mingzhu Zeng
  • About author:
    Corresponding author: Zeng Mingzhu, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

赵传喜, 曾明珠, 曾子全, 刘文刚. 髌骨缩小联合外侧支持带松解对膝关节置换术的疗效影响[J]. 中华关节外科杂志(电子版), 2019, 13(02): 168-172,241.

Chuanxi Zhao, Mingzhu Zeng, Ziquan Zeng, Wengang Liu. Analysis of effect of patellar reduction combined with lateral patellar retinaculum release after total knee arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2019, 13(02): 168-172,241.

目的

探讨髌骨缩小联合外侧支持带松解对人工全膝关节置换术后膝前痛发生及膝关节功能疗效的影响。

方法

筛选2016年1月至2017年6月广东省第二中医院骨科136例退行性膝骨关节炎拟行初次单侧全膝关节置换术的患者136例(136膝)，剔除同侧髋病及严重内外翻畸形膝，术前按随机分配法分为观察组(术中行髌骨缩小联合外侧支持带松解，68例)和对照组(术中常规去除髌骨边缘硬化骨但不松解外侧支持带，68例)，余手术操作均一致。记录两组患者术前术后膝前痛及并发症发生情况、手术时间、美国特种外科医院(HSS)膝关节评分、髌骨Feller评分、膝前痛评分，并进行术前术后和两组间的比较。拍摄术后膝关节正侧位和Merchant位X(屈膝30°髌骨轴位片)线片，观察髌骨轨迹情况。对计数资料和正态分布的计量资料采用卡方检验或t检验。

结果

观察组3例患者失访，2例外伤致胫腓骨骨折；对照组7例患者术中行"无拇指"试验发现需松解外侧支持带，排除研究；两组最终纳入63例和61例。所有患者均获得相同的随访时间。观察组术后膝前疼痛率为4.8%(3/63)，对照组为16.4%(10/61)，观察组优于对照组，差异有统计学意义(t＝6.325，P<0.05)；两组患者手术时间比较差异均无统计学意义(P>0.05)；术后18个月时两组患者HSS评分、Feller评分、膝前痛评分、膝关节活动度均较术前显著改善(P<0.05)；但观察组在HSS评分、髌骨Feller评分、膝前痛评分方面明显优于对照组(t＝3.125，P<0.05)；两组均未发生髌骨坏死、髌骨骨折、髌骨高压等并发症，比较差异无统计学意义(P>0.05)。观察组和对照组分别有2例和11例发生髌骨轨迹不良，比较差异有统计学意义(t＝11.218，P<0.05)。

结论

膝关节置换术中进行髌骨缩小联合外侧支持带松解能明显减少膝前痛及并发症发生，有效改善膝关节功能并较好维持术后髌骨的轨迹，提高TKA手术的整体疗效。

关键词: 膝, 关节成形术, 髌骨, 外科，整形, 侧副韧带, 髌股疼痛综合征
Objective

To investigate the effect of patellar reduction combined with lateral patellar retinaculum release on the occurrence of anterior knee pain and the knee joint function after total knee arthroplasty (TKA).

Methods

A total of 136 cases (136 cases) were collected from the Department of Orthopaedics, Second Hospital of Traditional Chinese Medicine, Guangdong Province between January 2016 and June 2017, excluding ipsilateral hip disease and severe internal and external valgus deformity knees. Before the operation, the patients were divided into two groups according to random distribution (patellar reduction combined with lateral patellar retinaculum release during operation, 68 cases), and the control group (removal of patella edge hardening bone but no lateral patellar retinaculum release, 68 cases); all the operative procedures were consistent. Preoperative and postoperative knee pain and complications, operation time, American Hospital of Special Surgery (HSS) score, patella Feller score, and anterior knee pain score were recorded before and after the surgery. X-ray film of knee joint and Merchant position (30 ° patella axis) were taken after operation to observe the patellar tracking. Chi-square test and t test were used to analyze the data.

Results

Three patients in the observation group were lost to follow up, and two patients were injured in the tibia. In the control group, seven patients underwent a "no thumb" test and found that the lateral patellar retinaculum needed to be released, they were not not involved in this research.The two groups eventually included 63 patients and 61 patients. All the patients got the follow-up at the same time. The preoperative knee pain rate was 4.8% (3/63) in the observation group and 16.4% (10/61) in the control group. The observation group was superior to the control group, and the different was significant (t=6.325, P<0.05). There was no obvious difference between the two groups in the operation time (P>0.05). At 18 months after operation, the HSS score, Feller score, anterior pain of knee score and knee joint activity were improved significantly in both groups (P <0.05). However, the HSS score, patella Feller score and anterior knee pain score were observed in the observation group, and the different was significant (t=3.125, P<0.05). There was no complication such as patellar necrosis, patellar fracture and patellar hypertension in the two groups, and there was no obvious difference between the two groups (P>0.05). There were two patients in the observation group and 11 patients in the control group with bad patellar tracking, and the difference was significant (t=11.218, P <0.05).

Conclusion

In the knee arthroplasty, patellar reduction combined with lateral patellar retinaculum release can reduce the incidence of anterior knee pain and complications significantly, improve knee function and maintain patellar tracking well, and improve the curative overall effect of TKA.

Key words: Knee, Arthroplasty, Patella, Surgery, plastic, Collateral ligaments, Patellofemoral pain syndrome
图1 髌骨缩小术步骤图。　图A为固定髌骨，摆锯剔除周围骨赘；图B　为截除髌骨外侧约1.5 cm骨质；图C　为打磨髌骨内侧缘及关节面；图D　为将髌骨进行缩小，使之与股骨假体滑车匹配
表1 两组患者治疗前基本资料比较
组别 例数 男/女(例) 年龄[岁，(±s)] BMI[kg/m2, (±s)] HSS评分(±s) Feller评分(±s) 膝前痛评分(±s)
观察组 63 14/49 63.2±4.8 22.8±3.2 51.8±15.1 12.1±5.5 3.1±2.8
对照组 61 11/50 64.1±5.2 23.1±2.9 53.2±12.6 11.7±6.2 3.3±1.9
统计值 ? χ2＝0.211 t＝－0.520 t＝0.828 t＝1.038 t＝1.227 t＝1.146
P值 ? >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
表2 两组患者膝前痛发生率及影像学结果比较
组别 例数 膝前痛发生率例(%) 髌骨轨迹不良(例)
髌骨倾斜>5° 髌骨移位>5 mm
观察组 63 3(4.8) 1 1
对照组 61 10(16.4) 4 7
χ2值 ? 6.325 11.218
P值 ? <0.05 <0.05
表3 两组患者手术时间及手术前后各项评分比较(±s)
组别 例数 手术时间(min) 膝前痛评分 髌骨Feller评分 HSS评分
术前 术后18个月 术前 术后18个月 术前 术后18个月
观察组 63 92.3±1.6 3.1±2.8 12.6±4.0 12.1±5.5 28.9±1.6 51.8±15.1 88.6±11.1
对照组 61 95.1±9.2 3.3±0.9 9.9±5.7 11.7±6.2 25.3±2.7 53.2±12.6 83.9±12.8
t值 ? 1.082 1.146 2.722 1.227 3.492 1.038 3.088
P值 ? >0.05 >0.05 <0.01 >0.05 <0.05 >0.05 <0.05
图2 屈膝30°髌骨X线轴位片。图A　为术前图像，示髌骨外移，大量骨赘增生，髌股间隙不等，髌股关节轨迹欠佳；图B　为术后图像，示整个髌骨缩小，外侧缘部分已截除，髌骨轨迹居中，较术前明显改善
[1]
Bontempi M, Cardinale U, Bragonzoni L, et al. Total knee replacement：intraoperative and postoperative kinematic assessment[J]. Acta Biomed, 2017, 8(2/S): 32-37.
[2]
Popovic N, Lemaire R. Anterior knee pain with a posteriorstabilized mobil-bearing knee prosthesis：the effect of femoralcom onent-design[J]．Arthroplasty, 2003, 18(4):396-400.
[3]
Petersen W, Rembitzki IV, Brüggemann GP, et al. Anterior knee pain after total knee arthroplasty: a narrative review[J]. Int Orthop, 2014, 38(2): 319-328.
[4]
Maquet P. Advancement of the tibial tuberosity[J]. Clin Orthop Relat Res, 1976, 5(115):225-230.
[5]
Ritter MA, Pierce MJ, Zhou HL, et al. Patellar complications (total knee arthroplasty) effect of lateral release and thickness[J]. Clin Orthop Relat Res, 1999, 11(367): 149-157.
[6]
Bindelglass DF. Rotational alignment of the tibial component in total knee arthroplasty[J]．Orthopedics, 2001, 24(11):1049-1052.
[7]
Feller JA, Bartlett RJ, Lang DM. Patellar resurfacing versus retention in total knee arthroplasty[J]. J Bone Joint Surg Br, 1996, 78(2): 226-228.
[8]
陈金伟，吕杰，俞银贤，等．膝骨关节炎中天然免疫和TLR/NF-κB信号通路的研究进展[J/CD]．中华临床医师杂志(电子版)，2013，7(24):11602-11606.
[9]
潘永谦，李健，杨波，等．全膝关节置换过程中髌股关节轨迹不良的处理[J]．中国组织工程研究，2013，13(13):2327-2332.
[10]
谢文光．髌骨修整对全膝关节置换疗效的影响[J]．内蒙古医学杂志，2017，49(7):857-859.
[11]
孙强，王英振，王昌耀．全膝关节置换术中髌骨置换与否对膝前痛发生的影响[J]．中国矫形外科杂志，2007，15(5):347-350.
[12]
胡军林，黄正，欧阳桂林，等．髌骨成形术对类风湿关节炎全膝关节置换术后髌骨轨迹和膝前痛的影响[J]．生物医学工程研究，2011，30(3):184-187.
[13]
吕厚山，主译．膝关节外科学[M]．第3版，北京：人民卫生出版社，2006：47：13－16.
[14]
黄志峰，翁习生，邱贵兴，等．髌骨置换与否对全膝关节置换效果的影响[J]．实用骨科杂志，2007，13(8):449-452.
[15]
唐竞，周一新．全膝关节置换术后髌股关节不稳定[J]．中华骨科杂志，2010，30(12): 1260-1266.
[16]
Zha GC, Sun JY, Dong SJ. Less anterior knee pain with a routine lateral release in total knee arthroplasty without patellar resurfacing：a prospective, randomized study[J]. Knee Surg Sports Traumatol Arthrosc, 2014, 22(3): 517-525.
[17]
舒云均．全膝关节置换术中外侧支持带松解对临床疗效的影响[J]．实用骨科杂志，2017，23(9):790-793,806.
[18]
Kusuma SK, Puri N, Lotke PA.Lateral retinacular release during primary total knee arthroplasty：effect on outcomes and complications[J]. Arthroplasty, 2009, 24(3): 383-390.
[19]
Molyneux S, Brenkel I. Predictors and outcomes of lateral release in total knee arthroplasty: a cohort study of 1859 knees[J]. Knee, 2012, 19(5): 688-691.
[20]
Blackman AJ, Smith JC, Luhmann SJ. Arthroscopic lateral retinacular release in adolescengts with medial patellofemoral ligamentcentered knee pain[J]．Pediarr Orthop, 2016, 36(3):268-273.
[1] 林文, 王雨萱, 许嘉悦, 王矜群, 王睿娜, 何董源, 樊沛. 人工关节置换登记系统的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 834-841.
[2] 闫文, 谢兴文, 顾玉彪, 雷宁波, 马成, 于文霞, 高亚雄, 张磊. 微小RNA与全膝关节置换术后深静脉血栓的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 842-846.
[3] 黄子荣, 罗渝鑫, 杨文瀚, 陈小虎, 谢环宇, 朱伟民. 前交叉韧带重建对膝关节稳定性影响的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 847-854.
[4] 樊绪国, 赵永刚, 杨砚伟. 腓骨在膝骨关节炎作用的研究观点[J]. 中华关节外科杂志(电子版), 2023, 17(06): 855-859.
[5] 贺敬龙, 尚宏喜, 郝敏, 谢伟, 高明宏, 孙炜, 刘安庆. 重度类风湿关节炎患者行多关节置换术的临床手术疗效[J]. 中华关节外科杂志(电子版), 2023, 17(06): 860-864.
[6] 孟繁宇, 周新社, 赵志, 裴立家, 刘犇. 侧位直接前方入路髋关节置换治疗偏瘫肢体股骨颈骨折[J]. 中华关节外科杂志(电子版), 2023, 17(06): 865-870.
[7] 王宏宇. 固定与活动平台假体在全膝关节置换术中的应用价值[J]. 中华关节外科杂志(电子版), 2023, 17(06): 871-876.
[8] 夏传龙, 迟健, 丛强, 连杰, 崔峻, 陈彦玲. 富血小板血浆联合关节镜治疗半月板损伤的临床疗效[J]. 中华关节外科杂志(电子版), 2023, 17(06): 877-881.
[9] 李善武, 叶永杰, 王兵, 王子呓, 银毅, 孙官军, 张大刚. 胫骨高位截骨与单髁置换的早期疗效比较[J]. 中华关节外科杂志(电子版), 2023, 17(06): 882-888.
[10] 李辉, 吴奇, 张子琦, 张晗, 王仿, 许鹏. 日间全膝关节置换术早期疗效及标准化流程探索[J]. 中华关节外科杂志(电子版), 2023, 17(06): 889-892.
[11] 金鑫, 谢卯, 刘芸, 杨操, 杨述华, 许伟华. 个性化股骨导向器辅助初次全髋关节置换的随机对照研究[J]. 中华关节外科杂志(电子版), 2023, 17(06): 780-787.
[12] 邓华梅, 袁札根, 曾德荣, 潘珊珊, 张葆青, 欧爱华, 曹学伟. 全膝关节置换术中气压止血带应用效果与影响因素分析[J]. 中华关节外科杂志(电子版), 2023, 17(06): 788-794.
[13] 中华医学会骨科分会关节学组. 中国髋、膝关节置换日间手术围手术期管理专家共识[J]. 中华老年骨科与康复电子杂志, 2023, 09(06): 321-332.
[14] 邱红生, 林树体, 梁朝莹, 劳世高, 何荷. 模拟现实步态训练对膝关节前交叉韧带损伤的功能恢复及对跌倒恐惧的影响[J]. 中华老年骨科与康复电子杂志, 2023, 09(06): 343-350.
[15] 付庆鹏, 邓晓强, 高伟, 姜福民, 范永峰, 吴海贺, 齐岩松, 包呼日查, 徐永胜. 新型股骨测量定位器在全膝关节置换术中的临床应用[J]. 中华临床医师杂志(电子版), 2023, 17(9): 980-987.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号