Rand J A
Mayo Medical School, Rochester, MN 55905.
Clin Orthop Relat Res. 1990 Nov(260):110-7.
Technical errors in patellar resurfacing at the time of total knee arthroplasty (TKA) are responsible for many of the complications that affect the patellofemoral joint. Instability, patellar fracture, and wear of metal-backed patellar implants are significantly affected by errors of patellar resurfacing. A review of 50 TKAs using a condylar prosthesis and a standardized technique for patellar resurfacing was performed to evaluate the accuracy of the technique. The patients were evaluated at a mean of 2.5 years (range, two to five years) after surgery. The Hospital for Special Surgery Knee Score improved from a preoperative mean of 56 to 92 at the last evaluation. The Hospital for Special Surgery Knee Scores were excellent in 92% and good in 8%. The Knee Society Knee Score improved from a preoperative mean of 28 for pain and 49 for function to a last evaluation mean of 96 for pain and 85 for function. None of the patients had symptoms referable to the patellofemoral joint. There were no patellar fractures, dislocations, or instances of implant loosening of the patella. Roentgenograms revealed nine asymmetrically resurfaced patellae and five tilted patellae. There were no patellar subluxations. Patellar thickness was maintained at the preoperative level of 21 mm. Joint-line height was elevated 1 mm. The patellar height was decreased 2 mm from the preoperative height. Using a standard technique, satisfactory clinical results can be achieved, but minor errors in resurfacing and alignment will still occur.
全膝关节置换术（TKA）时髌骨表面置换的技术失误是导致许多影响髌股关节并发症的原因。髌骨表面置换失误会显著影响金属背衬髌骨植入物的稳定性、髌骨骨折及磨损情况。我们对50例使用髁假体及标准化髌骨表面置换技术的TKA进行了回顾，以评估该技术的准确性。患者在术后平均2.5年（范围为2至5年）接受评估。在最后一次评估时，特种外科医院膝关节评分从术前平均56分提高到了92分。其中92%的患者特种外科医院膝关节评分为优秀，8%为良好。膝关节协会膝关节评分从术前疼痛平均28分、功能平均49分提高到最后评估时疼痛平均96分、功能平均85分。所有患者均无髌股关节相关症状。未发生髌骨骨折、脱位或髌骨植入物松动情况。X线片显示9例髌骨表面置换不对称，5例髌骨倾斜。无髌骨半脱位情况。髌骨厚度维持在术前21毫米的水平。关节线高度升高1毫米。髌骨高度较术前降低2毫米。采用标准技术可取得满意的临床效果，但仍会出现表面置换及对线方面的小失误。
