髌股关节置换治疗髌股关节骨关节炎的临床研究

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摘要目的探讨髌股关节置换术(patellofemoral arthroplasty，PFA)治疗髌股关节骨关节炎(patellofemoral osteoarthritis，PFOA)的临床疗效及手术技术、术中注意事项。方法回顾性分析2013年8月至2019年12月期间中国中医科学院望京医院关节一科住院患者采用PFA治疗PFOA患者134例，共146膝，其中男性46例，女性88例；年龄48～73岁，平均(52.4±7.6)岁；左膝86膝，右膝60膝；Dejour分型，A型23膝，B型49膝，C型54膝，D型20膝；病程8～53个月，平均(17.1±3.2)个月。对患者进行术前疼痛视觉模拟评分(visual analogue scale，VAS)、Lysholm膝关节评分，记录术后出现的关节感染、血肿等并发症，并于术后1个月、3个月、2年、4年分别进行随访，拍摄膝关节正侧位X线片及髌骨轴位片，并记录VAS、Lysholm评分及疗效评价、患者满意程度，进行统计学分析。结果患者术后均获得随访，随访时间17～53个月，平均(32.1±6.8)个月。134例146膝术后伤口I级愈合，满意程度高，治疗有效率97.95%。其中VAS评分由术前的(8.43±1.31)分降低至术后3个月时的(1.43±0.19)分，末次随访时VAS评分达(0.13±0.02)分，术前与末次随访比较差异有统计学意义(P＜0.05)。Lysholm膝关节评分由术前的(46.08±2.08)分提高到术后3个月时的(88.65±0.61)分，末次随访时达(97.92±0.49)分，术前与末次随访比较差异有统计学意义(P＜0.05)。随访过程中1例膝前疼并发髌骨倾斜，2例膑股关节弹响明显并发髌骨半脱位，以上3例患者均行翻修手术。1例翻修术后髌骨低位，未行再次翻修，其余患者未出现髌骨脱位、假体松动等并发症。结论采用第2代假体PFA手术可以解决单纯PFOA的问题，是治疗PFOA非手术治疗失败后的有效治疗方式，在临床实践中术前应严格掌握PFA的适应证及禁忌证，术中把握正确的操作要点，术后采取积极的康复锻炼指导，效果良好，其治疗方式值得临床推广使用。

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	刘思冶
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	汤吉祥
	李彦
	艾奇

关键词 ：膝, 髌股关节, 骨关节炎, 置换

Abstract：Objective To investigate the clinical efficacy，surgical techniques and intraoperative precautions of patellofemoral arthroplasty(PFA) for patellofemoral osteoarthritis(PFOA).Methods A retrospective analysis of 146 knees in 134 patients with PFOA treated by PFA surgery in our department from August 2013 to December 2019，including 46 males and 88 females，aged 48~73 (52.4±7.6) years old.86 cases of left knee and 60 cases of right knee were included.According to Dejour classification，there were 23 knees of Type A，49 knees of Type B，54 knees of Type C，20 knees of Type D.The course of disease was 8 to 53 (17.1±3.2) months，and the patients were evaluated by preoperative VAS score and Lysholm knee joint score.Complications such as joint infections and hematomas after the operation were followed up at 1 month，3 months，2 years，and 4 years after the operation.The front and side Xrays of the knee joint and the patella axial film were taken and recorded VAS，Lysholm scores，efficacy evaluation，and patient satisfaction were statistically analyzed.Results The average follow-up time was 17 to 53 (32.1±6.8) months.The postoperative wounds of 134 patients of 146 knees healed at grade I，with a high degree of satisfaction.The effective rate of treatment was 97.95%.The VAS score was based on the preoperative score of (8.43±1.31).It descends to (1.43±0.19) points three months after surgery，and the VAS score reached (0.13±0.02) points at the last followup.The difference was statistically significant (P＜0.05).The Lysholm knee score increased from (46.08±2.08) points before surgery to (88.65±0.61) points three months after surgery，and reached (97.92±0.49) points at the last followup.The difference was statistically significant (P＜0.05).During the follow-up，1 case of knee pain with tilted patella，2 cases of patellofemoral joint snapping and patellar subluxation，all the above 3 patients underwent revision surgery，1 case had lower patella after revision，and no revision was performed again.The remaining patients did not Complications such as dislocation of the patella and loosening of the prosthesis occurred.Conclusion The second-generation prosthetic PFA surgery can solve the problem of patellofemoral joint osteoarthritis.It is an effective treatment for PFOA after failure of non-surgical treatment.In clinical practice，the indications and contraindications of PFA should be strictly grasped.Grasp the correct operation points during the operation，and take active rehabilitation exercise guidance after the operation.The effect is good.The treatment method is worthy of clinical promotion.

Key words： knee patellofemoral joint osteoarthritis replacement

基金资助:北京市科技计划课题(Z201100005520058)

通讯作者: 荆琳

作者简介: 刘思冶(1996－ )，男，研究生在读，中国中医科学院望京医院骨关节一科，1773697753@qq.com

引用本文:

刘思冶，荆琳，张洪美，闫奇，汤吉祥，李彦，艾奇. 髌股关节置换治疗髌股关节骨关节炎的临床研究[J]. 实用骨科杂志, 2023, 29(6): 491-.
Liu Siye，Jing Lin，Zhang Hongmei，Yan Qi，Tang Jixiang，Li Yan，Ai Qi. A Clinical Study of Patellofemoral Joint Replacement in the Treatment of Patellofemoral Joint Osteoarthritis. sygkzz, 2023, 29(6): 491-.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2023/V29/I6/491

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