Wiberg分型对保留髌骨TKA术后髌骨轨迹及功能的影响

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Abstract Objective To study the patellar morphology，postoperative trajectory and function of total knee arthroplasty (TKA).Methods From January 2016 to January 2017，76 patients (81 knees) underwent total knee arthroplasty for osteoarthritis of the knee.The patients aged 53~77 years，with an average age of (66.19±6.83) years，including 21 males(22 knees) and 55 females(59 knees).Axial patellar films were taken on a digital X-ray imaging system with 45 degrees flexion and 30 degrees projection angle.Patellar classification was assessed by Wiberg criteria and patellofemoral inclination angle，patellofemoral index and patellofemoral fit angle were measured.During the operation，the patella was preserved，osteophytes around the patella were removed，and normal patellar anatomy was maintained.Preoperative Wiberg type Ⅰ patella was found in 18 case of knees，type Ⅱ in 49 case of knees and type Ⅲ in 14 case of knees.The imaging indexes and HSS functional score (HSS)，KSS functional score (KSS) and Fellar Patellar Score (Fellar Patellar Score)，upstairs and downstairs score and VAS score of anterior knee pain were compared before and after operation for different Wiberg patellar classification.Results The follow-up time was more than two years，and the average follow-up time was (25.16±6.24) months.Patellofemoral index decreased from preoperative (－10.04±4.74)degrees to postoperative (－7.54±4.61)degrees.The difference was statistically significant (P＝0.000).Patellofemoral index decreased from preoperative (1.50±0.54) to postoperative (1.17±0.59).The difference was statistically significant (P＝0.047).Preoperative tilt angle of patella of Wiberg type Ⅰ(－11.05±5.6)degrees，typeⅡ (－8.74±5.6)degrees，type Ⅲ(－13.22±3.72)degrees had significant difference (P＝0.013) before operation.Patellofemoral index of Wiberg type Ⅰ(1.53 ±0.53)，type Ⅱ (1.35±0.47)，and type type Ⅲ(1.95±0.58) had significant difference(P＝0.004).The preoperative patellar tilt angle and patellofemoral index of Wiberg Ⅱ patients were smaller than those of the other two types.There were significant differences in patellofemoral fitness angles among different Wiberg patellar types before operation.(P＝0.006).There was no significant difference in patellar tilt (P＝0.117)，patellofemoral index (P＝0.058) and suitable angle (P＝0.572) among different Wiberg classification patients (P＞0.05).There were no significant differences in HSS score (P＝0.572)，KSS clinical score (P＝0.657)，KSS functional score (P＝0.066)，patella score (P＝0.102)，upstairs and downstairs score (P＝0.080)，VAS score (P=0.332) among the patients with different Wiberg classification.Conclusion In total knee arthroplasty，good patellar trajectory and clinical effect can be achieved by patelloplasty and lateral retinaculum release.Wiberg's patellar morphology has no significant effect on the function after total knee arthroplasty with patellar preservation.

Key words： knee patellar trajectory morphology osteoarthritis fuction

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