Müller W, Wirz D
Kantonsspital Bruderholz, 4101 Bruderholz, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2001;9 Suppl 1:S24-6. doi: 10.1007/s001670000159.
Hingelike moving total knee replacement (TKR) has shown that the "rotating" function of the quadriceps muscle becomes lost. Dynamic work of the vastus medialis is no longer needed, and the static part of the quadriceps muscle assumes the major part of the work, beginning with continuously dislocating the patella to the lateral side. We operated on 436 knees using the LCS (De Puy Orthopaedics, Warsaw, IN) meniscal bearing TKR. No primary patellar resurfacing was necessary in this series. The New Jersey Score increased constantly over the 5-year follow-up from 83 after 2 years to 90 after 5 years. This shows that there is no deterioration which can be attributed to a deterioration in the patellar behavior. Nonresurfacing of the patella is a possible solution if the kinematics of the TKR allow physiological rotation, the prosthesis is built anatomically, the alignment is correct, the anatomy of decelerator/extensor mechanism is respected by the approach, and ligamentous stability is good.
绞链式活动全膝关节置换术（TKR）已表明股四头肌的“旋转”功能丧失。股内侧肌的动态作用不再需要，股四头肌的静态部分承担了主要工作，首先是持续将髌骨向外侧脱位。我们使用LCS（迪普伊骨科公司，印第安纳州华沙）半月板承载式TKR对436例膝关节进行了手术。本系列中无需进行初次髌骨表面置换。新泽西评分在5年随访期间持续升高，从2年后的83分升至5年后的90分。这表明不存在可归因于髌骨行为恶化的退变。如果TKR的运动学允许生理性旋转、假体按解剖结构制造、对线正确、手术入路尊重减速肌/伸肌机制的解剖结构且韧带稳定性良好，不进行髌骨表面置换是一种可行的解决方案。
