Liu Jun, Cao Jiangang, Zhang Yu, Tian Mengqiang, Wang Lei, Sun Yunbo, Sun Zhenhui, Wang Pei
Department of Orthopedics, General Hospital of Tianjin Medical University, 300052, P.R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011 Jan;25(1):33-7.
To investigate the management of extension apparatus and clinical results of total knee arthroplasty (TKA) of osteoarthritis.
Between June 2007 and June 2009, 386 patients (460 knees) with osteoarthritis received TKA, including 216 left knees and 244 right knees. There were 125 males (145 knees) and 261 females (315 knees) with an average age of 60.3 years (range, 58-85 years). The disease duration was 4-12 years (mean, 6.7 years). The X-ray films and CT scanning showed that all patients had femur-tibia joint degeneration and osteophyte formation at the edge of joint. According to modified Burnett patellar resurfacing indication, whether or not to replace the patellar was determined, and the patellar track was determined by combining no thumb test and towel clamp traction test. Patella resurfacing was performed in 53 cases (56 knees, resurfacing group), no patella resurfacing in 333 cases (404 knees, non-resurfacing group), and lateral retinacular releasing 68 cases (72 knees). The postoperative imaging and knee society score (KSS), patellofemoral complications were analyzed.
All wounds healed by first intention. All the patients were followed up 1-3 years (mean, 26 months). Deep infection occurred in 3 cases (1 case of resurfacing group and 2 cases of non-resurfacing group) at 3-7 months and they were cured after two-stage reversion. Patellofemoral complications occurred in 2 cases of resurfacing group (2/56, 3.57%) and in 9 cases of non-resurfacing group (9/404, 2.23%), showing no significant difference (chi2 = 0.38, P = 0.54). There were significant differences in KSS and visual analogue scale (VAS) at 2 and 3 year after operation when compared with before operation (P < 0.05). No significant difference in KSS and VAS of resurfacing group and non-resurfacing group were observed at 3 years after operation (P > 0.05).
It is benefit for selective patellar resurfacing and the patellar tract improvement to select patellar resurfacing indication according to the multi-factor assessment and to determine the patellar tract by combining no thumb test and towel clamp traction test, which can reduce the patellofemoral complication rate after TKA.
探讨骨关节炎全膝关节置换术（TKA）中伸膝装置的处理方法及临床效果。
2007年6月至2009年6月，386例（460膝）骨关节炎患者接受TKA，其中左膝216例，右膝244例。男性125例（145膝），女性261例（315膝），平均年龄60.3岁（范围58 - 85岁）。病程4 - 12年（平均6.7年）。X线片及CT扫描显示所有患者均有股骨 - 胫骨关节退变及关节边缘骨赘形成。根据改良的伯内特髌骨置换指征决定是否置换髌骨，结合无拇指试验和巾钳牵引试验确定髌股轨迹。53例（56膝）行髌骨置换（置换组），333例（404膝）未行髌骨置换（未置换组），68例（72膝）行外侧支持带松解。分析术后影像学及膝关节协会评分（KSS）、髌股并发症情况。
所有伤口均一期愈合。所有患者随访1 - 3年（平均26个月）。3例（置换组1例，未置换组2例）于3 - 7个月发生深部感染，经二期翻修治愈。置换组2例（2/56，3.57%）发生髌股并发症，未置换组9例（9/404，2.23%）发生髌股并发症，差异无统计学意义（χ² = 0.38，P = 0.54）。术后2年和3年时KSS及视觉模拟评分（VAS）与术前比较差异有统计学意义（P < 0.05）。术后3年置换组与未置换组KSS及VAS差异无统计学意义（P > 0.05）。
根据多因素评估选择髌骨置换指征，结合无拇指试验和巾钳牵引试验确定髌股轨迹，有利于选择性髌骨置换及髌股轨迹改善，可降低TKA术后髌股并发症发生率。
