Pollo F E, Jackson R W, Koëter S, Ansari S, Motley G S, Rathjen K W
Department of Orthopedic Surgery, Baylor University Medical Center, Dallas, Tex 75246, USA.
Am J Knee Surg. 2000 Spring;13(2):103-8; discussion 108-9.
During the past decade, the technology and design of knee joint prostheses has progressed considerably. However, there is still much controversy on whether resurfacing the patella during routine total knee arthroplasty (TKA) is necessary. This study compares the biomechanics of the lower limb in patients after TKA with and without patellar resurfacing during level walking, stair climbing, and chair rising. Eighteen patients who underwent TKA by two different surgeons using the same prosthesis were studied after full rehabilitation while walking, stair climbing, and chair rising. Patients were divided between those who were resurfaced and those who were not resurfaced. An aged-matched control population was recruited for comparison. The Hospital for Special Surgery Knee Rating Scale was used to gather clinical information. Kinematic and kinetic parameters were collected using a 5-camera Motion Analysis System and an AMTI OR6-5 force platform. For level walking, patients were asked to walk at a self-selected speed down an 8-m walkway. For stair climbing, patients were asked to climb a 4-step staircase without handrail support and for chair rising, patients were asked to rise from a chair that was positioned at the height of their knee joint line. Five trials for each side were recorded for averaging and statistical analysis. Temporal-spatial parameters and kinematic and kinetic variables at the knee joint were tested for significance using the repeated measures analysis of variance (ANOVA). There were no significant differences in the biomechanics of walking, stair climbing, or chair rising between patients after TKA with and without a resurfaced patella.
在过去十年中,膝关节假体的技术和设计有了显著进步。然而,在常规全膝关节置换术(TKA)中是否有必要对髌骨进行表面置换仍存在诸多争议。本研究比较了TKA术后患者在平路行走、爬楼梯和从椅子上起身时,髌骨表面置换组与未置换组下肢的生物力学情况。对18例由两位不同外科医生使用相同假体进行TKA手术的患者,在完全康复后进行行走、爬楼梯和从椅子上起身的研究。患者被分为髌骨表面置换组和未置换组。招募了年龄匹配的对照组进行比较。使用特种外科医院膝关节评分量表收集临床信息。使用5台摄像机的运动分析系统和AMTI OR6-5测力平台收集运动学和动力学参数。对于平路行走,要求患者以自选速度沿8米长的通道行走。对于爬楼梯,要求患者在无扶手支撑的情况下爬4级楼梯,对于从椅子上起身,要求患者从高度与膝关节线齐平的椅子上起身。每侧记录5次试验结果进行平均和统计分析。使用重复测量方差分析(ANOVA)对膝关节的时空参数以及运动学和动力学变量进行显著性检验。TKA术后髌骨表面置换组与未置换组患者在行走、爬楼梯或从椅子上起身的生物力学方面无显著差异。