發(fā)布時間：2018-04-04 17:39

  本文選題：人工全膝關(guān)節(jié)置換術(shù)　切入點：外側(cè)支持帶松解　出處：《中國修復(fù)重建外科雜志》2017年05期

【摘要】：目的探討髕骨保留型人工全膝關(guān)節(jié)置換術(shù)(total knee arthroplasty,TKA)中外側(cè)支持帶松解與否對臨床療效的影響。方法采用前瞻性隨機對照研究,將2012年10月—2014年10月收治并符合選擇標(biāo)準(zhǔn)的132例單側(cè)膝關(guān)節(jié)退變性關(guān)節(jié)炎患者隨機分為2組(n=66),試驗組TKA術(shù)中行髕骨外側(cè)支持帶松解,對照組術(shù)中不松解外側(cè)支持帶。試驗組2例患者失訪,對照組4例患者術(shù)中發(fā)現(xiàn)需松解外側(cè)支持帶,排除研究;試驗組和對照組最終納入64例和62例。兩組患者性別、年齡、體質(zhì)量指數(shù)、側(cè)別、病程及術(shù)前髕骨形態(tài)、髕股關(guān)節(jié)炎分級、髕骨軟骨退變等級、髕骨位置不良、髕骨軌跡不良、髕骨評分、膝關(guān)節(jié)學(xué)會評分系統(tǒng)(KSS)等一般資料比較,差異均無統(tǒng)計學(xué)意義(P0.05),具有可比性。記錄兩組患者手術(shù)時間、術(shù)后引流量、住院時間、術(shù)后并發(fā)癥及患者主觀滿意度;術(shù)后膝前痛采用疼痛視覺模擬評分(VAS)評估,采用KSS評分、髕骨評分評價膝關(guān)節(jié)功能;在X線片上測量股骨角、脛骨角、股骨屈曲角及脛骨后傾角評價假體力線;觀察術(shù)后髕骨軌跡及髕骨位置,以及有無骨溶解、假體松動、髕骨骨折和髕骨壞死等并發(fā)癥發(fā)生。結(jié)果術(shù)后兩組患者均隨訪24個月。兩組患者手術(shù)時間、術(shù)后引流量、住院時間、患者主觀滿意度比較差異均無統(tǒng)計學(xué)意義(P0.05);試驗組術(shù)后膝前痛發(fā)生情況優(yōu)于對照組(P=0.033)。兩組術(shù)后24個月KSS評分及髕骨評分均較術(shù)前顯著改善(P0.05);術(shù)后24個月時兩組間比較差異無統(tǒng)計學(xué)意義(P0.05)。術(shù)后發(fā)生血腫3例(試驗組2例、對照組1例),輕度切口裂開4例(各2例),切口皮緣壞死1例(試驗組),切口表淺感染2例(各1例),均經(jīng)保守治療痊愈;兩組均未發(fā)生髕骨壞死、髕骨骨折、膝外側(cè)痛等并發(fā)癥;兩組并發(fā)癥發(fā)生率比較差異無統(tǒng)計學(xué)意義(P=0.392)。隨訪期間兩組患者假體力線均滿意,兩組股骨角、脛骨角、股骨屈曲角及脛骨后傾角比較差異均無統(tǒng)計學(xué)意義(P0.05)。兩組骨水泥-骨界面均無透光帶及骨溶解。試驗組和對照組分別有3例和5例發(fā)生髕骨軌跡不良,比較差異無統(tǒng)計學(xué)意義(P=0.488);但試驗組髕骨位置不良發(fā)生率(18.8%)明顯低于對照組(35.5%)(χ~2=0.173,P=0.034)。結(jié)論髕骨保留型TKA術(shù)中行外側(cè)支持帶松解能夠降低術(shù)后膝前痛發(fā)生率,并且不增加術(shù)后并發(fā)癥發(fā)生風(fēng)險。
[Abstract]:Objective to investigate the patella retaining total knee arthroplasty (total knee, arthroplasty, TKA) of lateral retinacular release and the influence on clinical efficacy. Methods a prospective randomized controlled study, 132 cases were randomly divided into single knee joint degenerative arthritis patients from October 2012 to October 2014 and will meet the selection criteria for 2 group (n=66), TKA of experimental group in lateral retinaculum, control group were without release of the lateral retinaculum. The experimental group of 2 patients were lost to follow-up, 4 patients in control group were required to release of the lateral retinaculum, excluded studies; the test group and the control group included 64 cases and in 62 cases. Two groups of patients with gender, age, body mass index, side, duration and preoperative patellar morphology, patellofemoral osteoarthritis grading, patellar cartilage degeneration grade, patella bad location, patella maltracking, patellar score, Knee Society scoring system (KSS) etc. Comparison of general information, there were no significant differences (P0.05), comparable. Records of two groups of patients with operation time, postoperative drainage, hospitalization time, postoperative complications and patient satisfaction; postoperative anterior knee pain with visual analogue scale (VAS) assessed by KSS score, patellar score of knee joint function; measurement in X-ray femoral angle, tibial angle, femoral flexion angle and posterior tibial slope evaluation prosthesis force line; postoperative tracking of the patella and patella position, and there is no osteolysis, loosening, fracture of patella and patella occurred necrosis and other complications. Results two patients were followed up for 24 months. Two groups of patients with operation time, postoperative drainage, hospitalization time, satisfaction degree of patients showed no significant difference (P0.05); the experimental group postoperative incidence of anterior knee pain than the control group (P=0.033). The two groups 24 months after surgery, KSS score and evaluation of patella 鍒嗗潎杈冩湳鍓嶆樉钁楁敼鍠，

本文編號：1710986