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全膝关节置换术中的髌骨处理:综述

Patellar management during total knee arthroplasty: a review.

作者信息

McConaghy Kara, Derr Tabitha, Molloy Robert M, Klika Alison K, Kurtz Steven, Piuzzi Nicolas S

机构信息

Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.

Implant Research Core, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA.

出版信息

EFORT Open Rev. 2021 Oct 19;6(10):861-871. doi: 10.1302/2058-5241.6.200156. eCollection 2021 Oct.

Abstract

The optimal management of the patella during total knee arthroplasty (TKA) remains controversial and surgeons tend to approach the patella with one of three general mindsets: always resurface the patella, never resurface the patella, or selectively resurface the patella based on specific patient or patellar criteria.Studies comparing resurfacing and non-resurfacing of the patella during TKA have reported inconsistent and contradictory findings.When resurfacing the patella is chosen, there are a number of available patellar component designs, materials, and techniques for cutting and fixation.When patellar non-resurfacing is chosen, several alternatives are available, including patellar denervation, lateral retinacular release, and patelloplasty. Surgeons may choose to perform any of these alone, or together in some combination.Prospective randomized studies are needed to better understand which patellar management techniques contribute to superior postoperative outcomes. Until then, this remains a controversial topic, and options for patellar management will need to be weighed on an individual basis per patient. Cite this article: 2021;6:861-871. DOI: 10.1302/2058-5241.6.200156.

摘要

在全膝关节置换术(TKA)中,髌骨的最佳处理方式仍存在争议,外科医生倾向于以三种一般思维方式之一来处理髌骨:始终对髌骨进行表面置换、从不进行髌骨表面置换,或根据特定的患者或髌骨标准选择性地进行髌骨表面置换。比较TKA期间髌骨表面置换和不置换的研究报告了不一致且相互矛盾的结果。当选择对髌骨进行表面置换时,有多种可用的髌骨组件设计、材料以及切割和固定技术。当选择不进行髌骨表面置换时,有几种替代方法,包括髌骨去神经支配、外侧支持带松解和髌骨成形术。外科医生可以选择单独进行这些操作中的任何一种,或者以某种组合方式一起进行。需要进行前瞻性随机研究,以更好地了解哪些髌骨处理技术能带来更好的术后效果。在此之前,这仍然是一个有争议的话题,并且需要根据每个患者的具体情况权衡髌骨处理的选择。引用本文:2021;6:861 - 871。DOI: 10.1302/2058 - 5241.6.200156。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7cc2/8559560/d1c13ffa6962/eor-6-861-g001.jpg

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