Division of Orthopaedic Surgery, University of Western Ontario & London Health Sciences Centre, University Campus, 339 Windermere Road, London, ON, N6A 5A5, Canada.
Clin Orthop Relat Res. 2013 Feb;471(2):544-53. doi: 10.1007/s11999-012-2653-4.
The patella provides important mechanical leverage to the knee extensor mechanism. Patellectomy does not exclude the development of tibiofemoral arthrosis.
QUESTIONS/PURPOSES: We asked whether (1) TKA provides improvements in clinical outcome scores in patellectomized knees and (2) the scores of TKA in patellectomized knees are comparable to those in knees with intact patellae.
We evaluated 50 patients (52 primary TKAs) with patellectomized knees and a control group of 52 patients (52 primary TKAs) with intact patellae matched for age, sex, implant, and surgical year between 1984 and 2009. We compared the preoperative and latest postoperative SF-12, WOMAC, and Knee Society score (KSS). Minimum followup was 24 months (mean, 69 months; range, 24-204 months).
The mean WOMAC score in the control group improved from 41.8 (range, 7.5-72.4) preoperatively to 69.1 (range, 17.0-100.0) postoperatively, while that in the patellectomized group improved from 35.8 (range, 5.2-62.2) to 61.3 (range, 17.5-96.2). The mean KSS improved from 80.4 (range, 4.0-143.0) preoperatively to 161.4 (range, 69.0-200.0) postoperatively in the control group and from 76.9 (range, 5-134) to 136.8 (range, 7-199) in the patellectomized group. Mean postoperative WOMAC scores were comparable between the two groups, while the mean KSS was lower in the patellectomized group. The mean SF-12 scores were not different after TKA or between groups.
Despite the mechanical disadvantage to the knee extensor mechanism rendered by a previous patellectomy, TKA for tibiofemoral arthrosis in these patients relieved pain and restored function, but function was on average lower than that in patients with intact patellae.
Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
髌骨为膝关节伸肌机制提供了重要的机械杠杆作用。髌骨切除术后并不会排除胫股关节炎的发展。
问题/目的：我们想知道（1）TKA 是否能改善髌骨切除术后膝关节的临床结果评分，以及（2）髌骨切除术后膝关节的 TKA 评分是否与髌骨完整的膝关节评分相当。
我们评估了 50 名（52 例初次 TKA）髌骨切除术后患者和一组 52 名（52 例初次 TKA）髌骨完整的对照组患者，这些患者的年龄、性别、植入物和手术年份在 1984 年至 2009 年之间相匹配。我们比较了术前和最新的 SF-12、WOMAC 和膝关节协会评分（KSS）。最低随访时间为 24 个月（平均 69 个月；范围 24-204 个月）。
对照组的 WOMAC 评分从术前的 41.8（范围 7.5-72.4）改善到术后的 69.1（范围 17.0-100.0），而髌骨切除组从 35.8（范围 5.2-62.2）改善到 61.3（范围 17.5-96.2）。对照组的 KSS 从术前的 80.4（范围 4.0-143.0）改善到术后的 161.4（范围 69.0-200.0），而髌骨切除组从 76.9（范围 5-134）改善到 136.8（范围 7-199）。两组术后的 WOMAC 评分平均无差异，而髌骨切除组的 KSS 评分较低。TKA 后或两组之间的平均 SF-12 评分没有差异。
尽管先前的髌骨切除术对膝关节伸肌机制造成了机械上的不利影响，但对于这些患者的胫股关节炎，TKA 缓解了疼痛并恢复了功能，但功能平均低于髌骨完整的患者。
III 级，治疗性研究。有关证据水平的完整描述，请参阅作者说明。
