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人工全膝关节置换术中髌骨高度及倾斜角对远期膝关节活动度影响

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目的 探讨人工全膝关节置换术(total knee arthroplasty,TKA)中髌骨高度及倾斜角对远期膝关节活动度影响。方法 纳入 2020 年 1 月~2022 年 12 月于徐州医科大学附属医院行TKA且未行髌骨置换的患者 116 例。根据患者术后 1 年内膝关节活动度恢复情况,将患者分为膝关节活动度正常组(膝关节活动度≥120°)42 例和活动度下降组(膝关节活动度<120°)74 例。术后1 年,比较两组患者的髌骨高度和倾斜度;术后3 个月、术后1 年,记录两组患者的膝关节功能和膝关节疼痛的恢复状态。结果 116 例患者术后无神经、血管、韧带损伤,术后无髌骨脱位、感染发生,术后切口一期愈合良好。术后 1 年,正常组患者的髌骨高度Insall-Salvati比值和髌骨倾斜度低于下降组(P<0。05)。术前、术后 3 个月、术后 1 年,两组患者膝关节功能HSS评分逐渐升高,正常组HSS评分高于下降组(P<0。05);两组患者的膝关节疼痛评分逐渐降低,正常组疼痛评分低于下降组(P<0。05)。髌骨高度、髌骨倾斜度是TKA术后膝关节活动度下降的危险因素(P<0。05)。结论 未行髌骨置换的TKA患者,患者术后的膝关节活动度下降与术后髌骨高度增加及髌骨倾斜角增大相关。
The Effect of Patellar Height and Tilt Angle on Long-Term Knee Joint Mobility in Artificial Total Knee Arthroplasty
Objective To investigate the effects of the patellar height and tilt angle on the long-term knee joint mobility after total knee arthroplasty(TKA).Methods Totally,116 patients who underwent TKA without patellar replacement at Xuzhou Medical University Affiliated Hospital between January 2020 and December 2022 were included.Based on the recovery of the knee joint range of motion(ROM)within a year after surgery,the patients were divided into a normal knee ROM(knee ROM≥120°)group(42 cases)and descending knee ROM(knee ROM<120°)group(74 cases).A year after the surgery,the patellar heights and tilt angles of the two groups of patients were compared.The recovery status of knee function and pain between the two groups of patients at the third month and first year after surgery were recorded.Results None of the 116 patients had nerve,vascular,or ligament injuries after surgery.Moreover,no patellar dislocation or infection occurred.The incision healed well in the first postoperative period.A year after surgery,the Insall-Salvati ratio of patellar height and patellar inclination of the patients in the normal group was lower than that of the patients in the descending group(P<0.05).Prior to surgery,at the third month and first year after surgery,the HSS scores of knee function increased gradually in both the patient groups.The HSS scores of the normal group were higher than those of the decreasing group(P<0.05),the knee pain scores of both the groups decreased gradually,and the pain scores of the normal group were lower than those of the decreasing group(P<0.05).The patellar height and inclination were risk factors for decreased knee ROM after TKA(P<0.05).Conclusions Patients who underwent TKA without patellar replacement experienced a decrease in knee ROM after surgery.This is associated with an increase in the patellar height and tilt angle.

total knee arthroplasty(TKA)patellar replacementpatellar heightpatellar tilt angleknee joint range of motion

蒋健、王龙、冯骁、王海波、刘勇

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徐州医科大学附属医院 骨科,江苏 徐州 221000

全膝关节置换术 髌骨置换 髌骨高度 髌骨倾斜角 膝关节活动度

2024

医用生物力学
上海第二医科大学

医用生物力学

CSTPCD北大核心
影响因子:0.858
ISSN:1004-7220
年,卷(期):2024.39(6)