摘要目的 研究膝关节置换术中髌股关节压力对术后膝关节功能的影响。方法 本文随机选取2016年4月至2016年12月间接受膝关节置换术患者共24例，男8例，女16例，年龄在58~69岁，平均年龄为63.4岁，使用压敏片测量假体置换前后不同屈曲角度(30°、60°、90°及120°)时髌股关节生物应力情况。术后根据测得的压迹形状分为哑铃组和彗星组，对两组患者手术前后膝关节美国特种外科医院(the hospital special surgery，HSS)评分、关节活动度(range of motion，ROM)、膝前痛及髌骨评分等情况随访1~1.5年，平均13.4个月，并将结果进行统计学分析。结果 患者一般情况、术前HSS、ROM及假体置换前髌股关节应力情况差异均无统计学意义。根据压迹形状分组，14例患者纳入哑铃组，髌股关节压力分布正常，影像学显示髌骨无明显倾斜；10例患者纳入彗星组，其中7例患者髌股压力分布过于趋于外侧接触面，余3例压力分布主要趋于内侧接触面。术后影像学显示：10例彗星组患者髌骨有不同程度倾斜，随访结果显示两组患者术后HSS评分、ROM及膝前痛等情况均优于术前，差异有统计学意义(P＜0.05)；哑铃组kujala评分、ROM优于彗星组，差异有统计学意义(P＜0.05)；而组间HSS评分对比差异无统计学意义(P＞0.05)。结论 髌股关节压力对TKA术后膝关节功能恢复情况有一定的影响，术中应注意髌股关节生物力学的调整。
Abstract：Objective To investigate the effect of patellafemerol joint contact stress on the function of knee joint.Methods A total of 24 patients who accepted unilateral total knee arthroplasty(male 8 cases，female 16 cases)from April 2016 to December 2016.To measure the PFJS in different angle of knee flexion(30°、60°、90°、120°)before and after the prothesis was replaced with pressure sensitive films.The patients were divide into two groups according to the indentation(the dumbbell-shaped and the comet-shaped).The knee joint flexion，kujala score，HSS knee joint score and knee anterior pain were followed up for 1~1.5 years at lest The results were statistically processed.Results The general condition of the patient，preoperative HSS，ROM and the patellofemoral joint stress had no obvious statistical significance.According to indentation，14 patients were gouped into the dumbbell set.The patellofemoral joint pressure distribution was normal，and imaging showed no obvious tilt.10 patients grouped into the comet group，including 7 patients with patellofemoral pressure distribution too tends to the lateral contact surfaces，more than 3 main tending to the inside contact pressure distribution.Postoperative imaging showed all patients with patellar tilt to different exten.Follow-up results showed two groups of patients with postoperative HSS score，ROM and knee pain，were better than preoperative(P＜0.05).The dumbbell group’s kujala score and ROM were better than the comet group(P＜0.05).There was no significant difference between group HSS scores(P＜0.05).Conclusion Patellofemoral joint pressure has a certain effect on the recovery of knee joint function after TKA and the adjustment of patellofemoral joint biomechanics should be paid attention to.
［1］Fukagawa S，Matsuda S，Mizu-uchi H.Changes in patellar alignment after total knee arthroplasty［J］.Knee Surg Sports Traumatol Arthrosc，2011，19(1)：99-104.
［2］Armin Keshmiri，Günther Maderbacher，Clemens Baier.The influence of component alignment on patellar kinematics in total knee arthroplasty：An in vivo study using a navigation system［J］.Acta Orthopaedica，2015，86(4)：444-450.
［3］Aaron GR.The patella in revision total knee arthroplasty［J］.J Bone Joint Surg(Am)，2003，85(Suppl 1)：S63-70.
［4］Armstrong AD，Brien HJ，Dunning CE，et al.Patellar position after total knee arthroplasty：influence of femoral component malposition［J］.J Arthroplasty，2003，18(4)：458.
［5］Breugem SJ，Haverkamp D.Anterior knee pain after a total knee arthroplasty：What can cause this pain? ［J］.World J Orthop，2014，5(3)：163-170.
［6］杨滨，陈光兴，王志军，等.基于磁共振图像构建髌股关节三维有限元模型［J］.中国矫形外科杂志，2012，20(18)：1688-1691.
［7］吴浩，孟志超，曹永平，等.高屈曲后稳定型旋转平台假体和标准假体在全膝关节置换术后的早期疗效比较［J］.实用骨科杂志，2016，22(8)：673-677.
［8］Merican AM，Ghosh KM，Iranpour F，The effect of femoral component rotation on the kinematics of the tibiofemoral and patellofemoral joints after total knee arthroplasty［J］.Knee Surg Sports Traumatol Arthrosc，2011，19(9)：1479-1487.
［9］Verlinden C，Uvin P，Labey L，et al.The influence of malrotation of the femoral component in total knee replacement on the mechanics of patellofemoral contact during gait：an in vitro biomechanical study［J］.J Bone Joint Surg(Br)，2010，92(5)：737-742.
［10］KJ Rd，Chakravarty R，Cerynik DL，et al.Decreased ratios of lateral to medial patellofemoral forces and pressures after lateral retinacular release and gender kneesin total knee arthroplasty［J］.Knee Surg Sports Traumatol Arthrosc，2013，21(12)：2770-2778.
［11］Ten Ham AM，Wymenga AB，Jacobs WC.The use of the knee jointline balancer to control patella position in revision total knee arthroplasty［J］.Knee，2005，12(2)：89-92.
［12］Luo JW，Yu CT，Qin J.Rotational malalignment causing patellofemoral complications after total knee replacement［J］.Nanfang Yike Daxue Xuebao，2006，26(2)：217-219.
［13］DS Neogi，HB Ji，WS Chang.Impact of patellar height on unicompartment knee arthroplasty：does patella baja lead to an inferior outcome? ［J］.J Orthop Trauma，2014，15(1)：47-54.
［14］Hungerford DS.Biomechanics of the patellofemoral joint［J］.Clin Orthop，1979(144)：9-15.
［15］Reilly DT.Experimental analysis of the quadriceps muscle force and patellofemoral joint reaction force for various activities［J］.Orthop Scand，1972，43(2)：126-137.
［16］亓建洪，黄煌渊，李鸿儒.髌股关节生物力学研究及其意义［J］.国外医学(创伤与外科基本问题分册)，1993(3)：164-166；192.
［17］亓建洪，黄煌渊，李鸿儒.髌骨倾斜导致髌股关节接触压及面积改变［J］.中国运动医学杂志，1997，16(3)：183-186.
［18］季磊，陶巍栋.全膝关节置换术髌骨旁内侧入路和股内侧肌下入路对比研究［J］.实用骨科杂志，2016，22(8)：678-682.
晋公网安备 14010702070875号