全膝关节置换术中常规行外侧松解术可减少膝关节前侧疼痛，而不进行髌骨表面置换：一项前瞻性、随机研究。
Less anterior knee pain with a routine lateral release in total knee arthroplasty without patellar resurfacing: a prospective, randomized study.
机构信息
Orthopaedic Department, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu, People's Republic of China,
出版信息
Knee Surg Sports Traumatol Arthrosc. 2014 Mar;22(3):517-25. doi: 10.1007/s00167-013-2789-0. Epub 2013 Nov 28.
PURPOSE
Anterior knee pain is a major cause of complaint in total knee arthroplasty (TKA) without patellar resurfacing. The concept of improved patellar tracking and decreased retropatellar contact pressure for lateral retinacular release theoretically suggests that patients with lateral retinacular release in TKA would achieve a lower incidence of anterior knee pain when compared without lateral retinacular release. We sought to determine (1) whether those patients who received a routine lateral retinacular release in TKA would attain lower incidence of anterior knee pain as compared to patients who received TKA without lateral retinacular release and (2) whether lateral retinacular release would increase the lateral retinacular release-related complications.
METHODS
A total of 148 patients who underwent TKA with the use of the Gemini MK II mobile bearing were randomized to receive either routine lateral retinacular release (intervention group) or not (control group). Patients were assessed by the visual analogue scale for anterior knee pain, the Knee Society clinical scoring system of knee score and function score, and patellar score for clinical function. Patients' satisfaction and lateral retinacular release-related complications were also evaluated.
RESULTS
The overall incidence of anterior knee pain in the intervention group at 18 months follow-up was 5.6%, while that of the control group was 20.6% (p = 0.009). No statistical difference was detected between the two groups in terms of lateral retinacular release-related complications (n.s.), patients' satisfaction (n.s.), knee score (n.s.), function score (n.s.), and patellar score (n.s.) at 18 months follow-up.
CONCLUSION
The present study suggests that routine lateral retinacular release can reduce anterior knee pain and does not increase lateral retinacular release-related complications, in TKA with the use of the Gemini MK II mobile bearing without patellar resurfacing.
LEVEL OF EVIDENCE
Therapeutic, Level I.
目的
在未行髌骨表面置换的全膝关节置换术（TKA）中，前膝疼痛是主要的主诉原因。外侧支持带松解术改善髌骨轨迹和降低髌股关节接触压的概念理论上表明，与未行外侧支持带松解术的 TKA 患者相比，行 TKA 时行外侧支持带松解术的患者发生前膝疼痛的发生率较低。我们旨在确定：（1）与未行外侧支持带松解术的 TKA 患者相比，接受 TKA 常规外侧支持带松解术的患者前膝疼痛发生率是否较低；（2）外侧支持带松解术是否会增加外侧支持带松解术相关并发症。
方法
共 148 例接受 Gemini MK II 活动髌骨假体 TKA 的患者随机分为接受常规外侧支持带松解术（干预组）或不接受外侧支持带松解术（对照组）。采用视觉模拟评分法评估前膝疼痛，膝关节学会临床评分系统的膝关节评分和功能评分，以及髌骨临床功能评分评估患者临床功能。还评估了患者满意度和外侧支持带松解术相关并发症。
结果
干预组患者在 18 个月随访时前膝疼痛的总发生率为 5.6%，而对照组为 20.6%（p = 0.009）。两组在外侧支持带松解术相关并发症（n.s.）、患者满意度（n.s.）、膝关节评分（n.s.）、功能评分（n.s.）和髌骨评分（n.s.）方面在 18 个月随访时均无统计学差异。
结论
本研究表明，在未行髌骨表面置换的 Gemini MK II 活动髌骨假体 TKA 中，常规外侧支持带松解术可减少前膝疼痛，且不会增加外侧支持带松解术相关并发症。
证据等级
治疗性，一级。
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