Figgie H E, Goldberg V M, Figgie M P, Inglis A E, Kelly M, Sobel M
University Hospitals of Cleveland, Case Western Reserve School of Medicine, Ohio 44106.
J Bone Joint Surg Am. 1989 Aug;71(7):1031-9.
The results in thirty-six knees that had a fracture of the patella after a total condylar arthroplasty were reviewed, and were analyzed according to the type of fracture and the alignment of the implant and the limb. Most of the fractures occurred two years or less after the initial operation. Fourteen knees were rated fair or poor and twenty-two, good or excellent. None of the thirty-six implants had been aligned in the neutral range. In sixteen knees, the alignment had a minor variation from the neutral range--that is, the knees were in minor malalignment. In general, these knees had the least severe fractures and the best over-all results. All had a good or excellent result except one, which was revised because of a loose patellar component. That knee was rated as fair at the latest follow-up. There was a major discrepancy in the alignment of twenty implants. These knees had more severe fractures and less satisfactory results than those in the other group. In two of these knees, the fracture was treated non-operatively; one had a good and the other, a poor result. Twelve of the remaining knees, which were treated surgically, were rated as fair or worse. Two knees that had revision of three components and restoration of alignment to the neutral range had an excellent result. The results of this study indicate that the alignment and fit of a component are important in determining the severity of a fracture of the patella after condylar total knee replacement and the long-term results after treatment of the fracture.
回顾了36例全髁置换术后发生髌骨骨折的膝关节病例，并根据骨折类型、植入物及肢体对线情况进行分析。大多数骨折发生在初次手术后两年或更短时间内。14例膝关节评分为一般或较差，22例为良好或优秀。36例植入物均未处于中立位对线。16例膝关节的对线与中立位有微小差异，即膝关节存在轻度畸形。总体而言，这些膝关节骨折最轻，总体结果最佳。除1例因髌骨部件松动而翻修外，其余均取得良好或优秀的结果。该膝关节在最近一次随访时评分为一般。20例膝关节的对线存在较大差异。这些膝关节骨折更严重，结果不如另一组。其中2例膝关节采用非手术治疗骨折；1例效果良好，另1例较差。其余12例接受手术治疗的膝关节评分为一般或更差。2例翻修了三个部件并将对线恢复到中立位的膝关节取得了优秀的结果。本研究结果表明，部件的对线和匹配对于决定髁型全膝关节置换术后髌骨骨折的严重程度以及骨折治疗后的长期结果很重要。
