在 LCS 活动平台型全膝关节置换术中，比较保留与表面置换髌骨的效果。
Comparison of patellar retention versus resurfacing in LCS mobile-bearing total knee arthroplasty.
机构信息
Department of Orthopaedic Surgery, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2012 Mar;20(3):524-31. doi: 10.1007/s00167-011-1593-y. Epub 2011 Jul 1.
PURPOSE
The aim of this retrospective study was to compare clinical outcomes of total knee arthroplasty (TKA) with and without patellar resurfacing using the Low Contact Stress (LCS) mobile-bearing prosthesis in 275 osteoarthritic knees (199 patients) after a minimum of 7 years of follow-up.
METHODS
Patients were divided into a patellar retention group (132 knees) and a resurfacing group (143 knees), with median follow-up durations of 7.8 years (range, 7-8.5 years) and 8.5 years (range, 7-10.6 years), respectively. The demographics of the two groups were otherwise matched. The patelloplasty was performed for patellar retention. Patients were evaluated by a blinded, independent observer using Feller's patellar score, the Knee Society score, patient satisfaction, patellar tilt, and lateral displacement.
RESULTS
Patellar resurfacing was not superior to retention with respect to any of the measured variables. Eight knees (6.1%) without and 6 (4.2%) with patellar resurfacing had anterior knee pain related to the patellofemoral joint (n.s.). The reoperation rate related to the patellofemoral joint was 0.8% (n = 1) in the retention group compared with 2.8% (n = 4) in the resurfacing group (n.s.). In the 35 patients who underwent bilateral TKA with patellar resurfacing on only one side, there were no significant differences between the two sides in subjective preference, clinical scores, or functional ability.
CONCLUSIONS
The clinical and radiographic outcomes of TKA with the LCS mobile-bearing prosthesis showed no significant difference between the two groups after a minimum of 7 years of follow-up. The findings in this study suggest that patellar retention with a patelloplasty may be viable as a routine procedure, even in knees with advanced patellofemoral arthritis, if soft tissue balancing and a patella-friendly prosthetic design are properly used.
LEVEL OF EVIDENCE
Therapeutic, retrospective, comparative study, Level III.
目的
本回顾性研究旨在比较使用 Low Contact Stress（LCS）活动型假体行全膝关节置换术（TKA）时髌骨保留与髌骨表面置换的临床结果，共纳入 275 例（199 例患者）膝关节骨关节炎患者，随访时间至少 7 年。
方法
患者分为髌骨保留组（132 膝）和髌骨表面置换组（143 膝），两组的中位随访时间分别为 7.8 年（7-8.5 年）和 8.5 年（7-10.6 年）。两组的一般资料相匹配。髌骨保留组行髌骨成形术。采用 Feller 髌骨评分、膝关节学会评分、患者满意度、髌骨倾斜度和外侧移位评估两组患者。
结果
髌骨表面置换在所有测量变量上均不比髌骨保留优越。8 膝（6.1%）无髌骨表面置换和 6 膝（4.2%）有髌骨表面置换出现髌股关节相关的膝关节前痛（无统计学差异）。髌骨保留组的髌股关节相关翻修率为 0.8%（n=1），髌骨表面置换组为 2.8%（n=4）（无统计学差异）。在 35 例仅一侧行 TKA 并髌骨表面置换的患者中，两侧的主观偏好、临床评分或功能能力均无显著差异。
结论
在至少 7 年的随访后，LCS 活动型假体 TKA 的临床和影像学结果在两组之间无显著差异。本研究结果表明，如果软组织平衡和髌骨友好型假体设计得到正确应用，髌骨保留伴髌骨成形术在伴有晚期髌股关节炎的膝关节中作为常规手术可能是可行的。
证据等级
治疗性、回顾性、比较性研究，III 级。
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