髌骨再处理真的重要吗？初次全膝关节置换术后 972 例患者的疼痛和功能。
Does patella resurfacing really matter? Pain and function in 972 patients after primary total knee arthroplasty.
机构信息
The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Norway.
出版信息
Acta Orthop. 2010 Feb;81(1):99-107. doi: 10.3109/17453671003587069.
BACKGROUND AND PURPOSE
Resurfacing of the patella during primary total knee arthroplasty (TKA) is often recommended based on higher revision rates in non-resurfaced knees. As many of these revisions are insertions of a patella component due to pain, and since only patients with a non-resurfaced patella have the option of secondary resurfacing, we do not really know whether these patients have more pain and poorer function. The main purpose of the present paper was therefore to assess pain and function at least 2 years after surgery for unrevised primary non-resurfaced and resurfaced TKA, and secondary among prosthesis brands.
METHODS
Information needed to calculate subscales from the knee injury and osteoarthritis outcome score (KOOS) was collected in a questionnaire given to 972 osteoarthritis patients with intact primary TKAs that had been reported to the Norwegian Arthroplasty Register. Pain and satisfaction on visual analog scales and improvement in EQ-5D index score DeltaEQ-5D) were also used as outcomes. Outcomes were measured on a scale from 0 to 100 units (worst to best). To estimate differences in mean scores, we used multiple linear regression with adjustment for possible confounders.
RESULTS
We did not observe any differences between resurfacing and non-resurfacing in any outcome, with estimated differences of <or= 1.4 units and p-values of > 0.4. There was, however, a tendency of better results for the NexGen implant as compared to the reference brand AGC for symptoms (difference = 4.9, p = 0.05), pain (VAS) (difference = 8.3, p = 0.004), and satisfaction (VAS) (difference = 7.9, p = 0.02). However, none of these differences reached the stated level of minimal perceptible clinical difference.
INTERPRETATION
Resurfacing of the patella has no clinical effect on pain and function after TKA. Differences between the brands investigated were small and they were assumed to be of minor importance.
背景与目的
初次全膝关节置换术（TKA）中常建议对髌骨进行表面处理，因为未进行表面处理的膝关节翻修率较高。由于这些翻修术中有许多是由于疼痛而植入髌骨组件，而且只有未进行表面处理的髌骨患者才有进行二次表面处理的选择，因此我们并不知道这些患者是否有更多的疼痛和更差的功能。因此，本文的主要目的是评估初次未进行表面处理和进行表面处理的 TKA 以及不同品牌的二次翻修术后至少 2 年的疼痛和功能情况。
方法
通过问卷调查收集了挪威关节置换登记处报告的 972 例未翻修的原发性 TKA 患者的膝关节损伤和骨关节炎结局评分（KOOS）子量表所需的信息。视觉模拟量表上的疼痛和满意度以及 EQ-5D 指数评分改善（DeltaEQ-5D）也作为结果进行测量。结果的测量范围为 0 到 100 个单位（最差到最好）。为了估计平均得分的差异，我们使用了具有可能混杂因素调整的多元线性回归。
结果
我们没有观察到表面处理和非表面处理在任何结果之间有任何差异，估计差异<或=1.4 个单位，p 值>0.4。然而，与参考品牌 AGC 相比，NexGen 植入物在症状（差异=4.9，p=0.05）、疼痛（VAS）（差异=8.3，p=0.004）和满意度（VAS）（差异=7.9，p=0.02）方面的结果更好。然而，这些差异均未达到最小可察觉临床差异的设定水平。
解释
髌骨表面处理对 TKA 后疼痛和功能没有临床影响。所研究的品牌之间的差异较小，我们认为这是次要的。
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