Oztürk Alpaslan, Bilgen Sadik, Atici Teoman, Ozer Ozgür, Bilgen Omer Faruk
Department of Orthopedics and Traumatology (Ortopedi ve Travmatoloji Kliniği), Bursa Yüksek Ihtisas Hospital, Bursa, Turkey.
Acta Orthop Traumatol Turc. 2006;40(1):29-37.
We evaluated the clinical and radiographic results of total knee arthroplasty (TKA) with or without patellar resurfacing.
The study included 149 knees of 126 patients who underwent TKA for primary knee osteoarthritis with (59 knees, group 1) or without (90 knees, group 2) patellar resurfacing. Clinical evaluations were made with the knee and function scores of the Knee Society, and patella scoring system; radiographic evaluations included changes in the joint line, Insall-Salvati ratio, lateral patellofemoral angle, and congruency angle. The mean follow-up period was 66.7 months (range 34 to 123 months) in group 1, and 68.1 months (range 30 to 117 months) in group 2.
Although postoperative knee and function scores showed significant improvements in both groups (p<0.001), these did not reach significance between the two groups (p>0.05). The mean patella scores did not differ significantly, either (p>0.05). Postoperative radiographic assessments did not show significant differences between the two groups with respect to mechanical axis values, patellar tilt, and lateral subluxation (p>0.05). Symptomatic patellar subluxation, dislocation, fracture or rupture of the extensor mechanism did not occur in any of the treatment groups. None of the patients required revision associated with the patella and patellar prosthesis.
Our findings suggest that patellar resurfacing is not necessary other than patients with significant degeneration of the patellar surface.
我们评估了全膝关节置换术(TKA)在有或没有髌骨表面置换情况下的临床和影像学结果。
本研究纳入了126例因原发性膝关节骨关节炎接受TKA的患者的149个膝关节,其中59个膝关节(第1组)进行了髌骨表面置换,90个膝关节(第2组)未进行髌骨表面置换。采用膝关节协会的膝关节和功能评分以及髌骨评分系统进行临床评估;影像学评估包括关节线变化、Insall-Salvati比率、外侧髌股角和适合角。第1组的平均随访期为66.7个月(范围34至123个月),第2组为68.1个月(范围30至117个月)。
尽管两组术后膝关节和功能评分均有显著改善(p<0.001),但两组之间差异无统计学意义(p>0.05)。平均髌骨评分差异也无统计学意义(p>0.05)。术后影像学评估显示,两组在机械轴值、髌骨倾斜和外侧半脱位方面差异无统计学意义(p>0.05)。任何治疗组均未出现有症状的髌骨半脱位、脱位、骨折或伸肌机制破裂。所有患者均无需因髌骨和髌骨假体进行翻修。
我们的研究结果表明,除髌骨表面有明显退变的患者外,髌骨表面置换并非必要。