术前髌骨倾斜角对全膝关节置换术后疗效的影响
The effect of preoperative patellar tilt angle on postoperative outcome of total knee arthroplasty
周皓 1沈凯 1王锦文 1谈正岗 1范卫民 1刘锋 1刘久翔1
作者信息
- 1. 南京医科大学第一附属医院骨科,南京 210029
- 折叠
摘要
目的 探讨术前髌骨倾斜角对全膝关节置换(total knee arthroplasty,TKA)术后临床疗效的影响.方法 回顾性分析南京医科大学第一附属医院2020年10月至2022年9月因膝关节骨关节炎行TKA(术中未行髌骨置换)的患者277例,男72例、女205例,年龄(69.16±6.77)岁(范围52～87岁),体质指数(27.01±3.81)kg/m2(范围 18.14～39.01 kg/m2).根据术前髌骨倾斜角的大小将患者分为三组:倾斜角＜5°为轻度倾斜组、5°≤倾斜角＜10°为中度倾斜组、倾斜角≥10°为重度倾斜组.轻度组103例、中度组137例、重度组37例.比较手术前后膝前疼痛视觉模拟评分(visual analogue score,VAS)、美国特种外科医院(Hospital for Special Surgery,HSS)评分及髌骨Feller评分.结果 所有患者均获得随访,随访时间为(15.73±3.06)个月(范围12～22个月).术前髌骨倾斜角为6.86°±3.55°,术后改善至3.63°±2.61°,差异有统计学意义(t=19.086,P＜0.001).轻度组、中度组及重度组术后髌骨倾斜角均变小,与术前比较差异有统计学意义(P＜0.05).三组患者术后膝前VAS评分均降低,与术前比较差异有统计学意义,其中术后3、6、12个月的膝前VAS评分均小于术前;术后6、12个月组间比较差异均有统计学意义(P＜0.05),重度组膝前VAS评分为(2.59±0.55)分、(2.03±0.55)分,大于轻度组的(2.15±0.38)分、(1.57±0.50)分和中度组的(2.19±0.49)分、(1.67±0.61)分.三组患者术后HSS评分均增加,与术前比较差异有统计学意义(P＜0.05),其中术后3、6、12个月的HSS评分均大于术前.术后6、12个月组间比较差异均有统计学意义(P＜0.05),重度组HSS评分为(86.27±2.04)分、(87.73±2.28)分,小于轻度组的(89.02±2.33)分、(89.83±1.48)分和中度组的(88.77±2.83)分、(89.52±1.95)分.三组患者术后髌骨Feller评分均增加,与术前比较差异有统计学意义(P＜0.05),其中术后3、6、12个月的髌骨Feller评分均大于术前.术后6、12个月组间比较差异均有统计学意义(P＜0.05),重度组髌骨Feller评分为(18.32±1.99)分、(20.32±1.60)分,小于轻度组的(20.92±1.01)分、(23.07±1.39)分和中度组的(20.91±1.95)分、(22.69±1.59)分.结论 未行髌骨置换的TKA术前髌骨倾斜角增大可导致术后膝前疼痛、膝关节功能降低.
Abstract
Objective To investigate the effect of preoperative patellar tilt angle on postoperative outcome of total knee arthroplasty(TKA).Methods A total of 277 patients with knee osteoarthritis who underwent TKA without patellar replacement in the First Affiliated Hospital of Nanjing Medical University from October 2020 to September 2022 were retrospectively analyzed.There were 72 males and 205 females,aged 69.16±6.77 years(range,52-87 years),body mass index 27.01±3.81 kg/m2(range 18.14-39.01 kg/m2).The patients were divided into three groups according to the preoperative tilt angle of the patella:tilt angle＜5° for mild tilt group,5°≤tilt angle＜10° for moderate tilt group,and tilt angle≥10° for severe tilt group.There were 103 cases in the mild group,137 cases in the moderate group,and 37 cases in the severe group.The preoperative and postoperative visual ana-logue scale(VAS),Hospital for Special Surgery(HSS)score and Feller's score of patella were compared.Results All patients were followed up for 15.73±3.06 months(range,12-22 months).The patellar tilt angle was 6.86°±3.55° preoperatively and 3.63°±2.61° postoperatively(t=19.086,P＜0.001).The patellar tilt angle of mild group,moderate group and severe group decreased after operation,and the difference was statistically significant compared with that before operation(P＜0.05).The anterior knee VAS of the three groups decreased after operation,and the differences were statistically significant compared with those before operation.The anterior knee VAS at 3,6,and 12 months after operation were lower than those before operation.The differences between groups at 6 and 12 months postoperatively were statistically significant(P＜0.05),with anterior knee VAS scores of 2.59±0.55 and 2.03±0.55 in the severe group being greater than those of 2.15±0.38 and 1.57±0.50 in the mild group and 2.19±0.49 and 1.67±0.61 in the moderate group.The HSS score of the three groups was increased after operation,and the difference was statistically significant compared with that before operation(P＜0.05),and the HSS scores at 3,6 and 12 months after operation were higher than those before operation.There were significant differences at 6 and 12 months after operation(P＜0.05),the HSS scores of the severe group were 86.27±2.04 and 87.73±2.28,which were lower than those of the mild group 89.02±2.33 and 89.83±1.48,and the moderate group 88.77±2.83 and 89.52±1.95.Postoperative patellar Feller score increased in all three groups,and the differ-ence was statistically significant compared with that before operation(P＜0.05),the patellar Feller score at 3,6 and 12 months after operation was higher than that before operation.There were significant differences at 6 and 12 months after operation(P＜0.05),the patellar Feller scores in the severe group were 18.32±1.99 and 20.32±1.60,which were lower than those in the mild group 20.92±1.01 and 23.07±1.39 and the moderate group 20.91±1.95 and 22.69±1.59.Conclusion In TKA patients without patella replace-ment,the increase of patellar tilt angle before operation can lead to anterior knee pain and reduced knee function.
关键词
骨关节炎,膝/关节成形术,置换,膝/髌骨/疼痛Key words
Osteoarthritis,knee/Arthroplasty,replacement,knee/Patella/Pain引用本文复制引用
出版年
2024
NETL
NSTL
万方数据