不置换髌骨的活动平台膝关节置换术后膝前痛的中期随访

doi:10.3969/j.issn.1006-7795.2018.05.021

摘要/Abstract

摘要： 目的比较行固定平台和活动平台人工膝关节置换的患者术后的中期膝前痛情况。方法选取2006至2009年于首都医科大学附属北京同仁医院骨科行固定平台和活动平台膝关节置换的患者作为研究对象，将其分为固定平台组和活动平台组。所有患者均未置换髌骨。记录患者术前术后膝前痛发生率、膝前痛评分、髌骨评分、KSS功能评分（Knee Society Function Score），并进行术前术后和两组间的比较。拍摄术后膝关节正侧位和Merchant位X线片，观察髌骨位置情况。结果共63人、85膝纳入研究。其中活动平台组31人、45膝，随访时间3.9~7.6年，平均（5.9±1.1）年。固定平台组30人、40膝，随访4.2~8.1年，平均（6.4±1.3）年。两组患者术后膝前痛评分、髌骨评分、KSS功能评分均较术前有明显提高，但两组患者间术后上述评分差异无统计学意义。两组患者间术后膝前痛发生率差异也无统计学意义。两组患者术后X-ray均未显示明显的髌骨脱位或半脱位。结论非置换髌骨的活动平台和固定平台膝关节置换术均可以有效地缓解膝前痛、恢复膝关节功能，术后中期效果满意。相比固定平台假体，活动平台假体的应用并未显著地改善术后膝前痛情况。

关键词: 人工膝关节, 活动平台, 固定平台, 膝前痛, 中期随访

Abstract: Objective Evaluate the medium-term anterior knee pain result of total knee arthroplasty (TKA) using mobile-bearing (MB) and fixed-bearing (FB) prosthesis.Methods The patients who suffer from osteoarthritis or rheumatoid arthritis and receiving TKA with MB and FB prosthesis during 2006-2009 were followed up,then divided them into two corresponding groups(Group MB,Group FB). All the patients were not be replaced the patella.The postoperative anterior knee pain incidence,Knee Society Function Score,Patellar Score and the Anterior Knee Pain Score were collected,which were compared with preoperation and with another group. The Anterior-Posterior, lateral and Merchant position X-ray pictures were taken to evaluate the patella position.Results 63 patients,85 knees were followed up. The MB group contain 31 patients,45 knees,the mean follow-up period was (5.9±1.1) years(3.9-7.6 years).The FB group contain 30 patients,40 knees,the mean follow-up period was (6.4±1.3) years(34.2-8.1 years).The postoperative scores were significantly higher than preoperation,but there are no differences between the two groups,as well as the anterior knee pain incidence.No patella dislocation or subluxation were found in the postoperative X-ray examination. Conclusion Both mobile-bearing and fix-bearing TKA can relieve anterior knee pain effectively and recovery knee function,the medium-term clinical results are satisfactory.But comparing with FB,the application of the MB prosthesis did not improve the anterior knee pain more.

Key words: total knee arthroplasty, mobile-bearing, fixed-bearing, anterior knee pain, medium-term follow up

中图分类号:

R687.4

强华, 王国栋, 郭艾, 赵尔弘. 不置换髌骨的活动平台膝关节置换术后膝前痛的中期随访[J]. 首都医科大学学报, 2018, 39(5): 736-740.

Qiang Hua, Wang Guodong, Guo Ai, Zhao Erhong. Medium-term follow up the anterior knee pain of mobile and fixed bearing total knee arthroplasty without patella replacement[J]. Journal of Capital Medical University, 2018, 39(5): 736-740.

参考文献

[1] Goodman S M, Springer B, Guyatt G,et al.2017 American college of Rheumatology/American association of hip and knee surgeons guideline for the perioperative management of antirheumatic medication in patients with rheumatic diseases undergoing elective total hip or total knee arthroplasty[J].J Arthroplasty, 2017,32(9):2628-2638.
[2] Bontempi M, Cardinale U, Bragonzoni L, et al. Total knee replacement:intraoperative and postoperative kinematic assessment[J].Acta Biomed, 2017,8(2-S):32-37.
[3] McGrory B, Weber K, Lynott J A,et al.The American academy of orthopaedic surgeons evidence-based clinical practice guideline on surgical management of osteoarthritis of the knee[J].J Bone Joint Surg Am, 2016,98(8):688-692.
[4] Lee G C. What's new in adult reconstructive knee surgery[J].J Bone Joint Surg Am, 2017, 99(2):164-174.
[5] Grosu I, Lavand'homme P, Thienpont E. Pain after knee arthroplasty:an unresolved issue[J].Knee Surg Sports Traumatol Arthrosc,2014,22(8):1744-1758.
[6] Petersen W, Rembitzki I V, Brüggemann G P,et al. Anterior knee pain after total knee arthroplasty:a narrative review[J].Int Orthop, 2014,38(2):319-328.
[7] Shervin D, Pratt K, Healey T, et al.Anterior knee pain following primary total knee arthroplasty[J].World J Orthop, 2015,6(10):795-803.
[8] Breugem S J, Haverkamp D. Anterior knee pain after a total knee arthroplasty:What can cause this pain?[J].World J Orthop, 2014,5(3):163-170.
[9] Skwara A, Tibesku C O, Ostermeier S, et al. Differences in patellofemoral contact stresses between mobile-bearing and fixed-bearing total knee arthroplasties:a dynamic in vitro measurement[J].Arch Orthop Trauma Surg, 2009,129(7):901-907.
[10] Callaghan J J, Squire M W, Goetz D D, et al. Cemented rotating-platform total knee replacement. A nine to twelve-year follow-up study[J].J Bone Joint Surg Am, 2000,82(5):705-711.
[11] Meftah M, Ranawat A S, Ranawat C S. The natural history of anterior knee pain in 2 posterior-stabilized, modular total knee arthroplasty designs[J].J Arthroplasty, 2011,26(8):1145-1148.
[12] Feller J A, Bartlett R J, Lang D M. Patellar resurfacing versus retention in total knee arthroplasty[J].J Bone Joint Surg Br, 1996,78(2):226-228.
[13] Steinbrück A, Schröder C, Woiczinski M,et al.Patellofemoral contact patterns before and after total knee arthroplasty:an in vitro measurement[J].Biomed Eng Online, 2013,12:58.
[14] Steinbrück A, Schröder C, Woiczinski M,et al.Influence of tibial rotation in total knee arthroplasty on knee kinematics and retropatellar pressure:an in vitro study[J].Knee Surg Sports Traumatol Arthrosc, 2016,24(8):2395-2401.
[15] 陶坤,蔡明,张立国,等.旋转平台全膝关节置换术中胫骨假体的旋转安放及相关研究[J].中华骨与关节外科杂志, 2009, 2(4):264-268.
[16] Nicoll D, Rowley D I. Internal rotational error of the tibial component is a major cause of pain after total knee replacement[J].J Bone Joint Surg Br,2010,92(9):1238-1244.
[17] Sawaguchi N, Majima T, Ishigaki T, et al.Mobile-bearing total knee arthroplasty improves patellar tracking and patellofemoral contact stress:in vivo measurements in the same patients[J].J Arthroplasty, 2010,25(6):920-925.
[18] Skwara A, Tibesku C O, Ostermeier S,et al.Differences in patellofemoral contact stresses between mobile-bearing and fixed-bearing total knee arthroplasties:a dynamic in vitro measurement[J].Arch Orthop Trauma Surg,2009,129(7):901-907.
[19] Breugem S J, Sierevelt I N, Schafroth M U,et al.Less anterior knee pain with a mobile-bearing prosthesis compared with a fixed-bearing prosthesis[J].Clin Orthop Relat Res, 2008,466(8):1959-1965.
[20] Capella M, Dolfin M, Saccia F.Mobile bearing and fixed bearing total knee arthroplasty[J].Ann Transl Med, 2016, 4(7):127.
[21] Bistolfi A, Massazza G, Lee G C,et al.Comparison of fixed and mobile-bearing total knee arthroplasty at a mean follow-up of 116 months[J].J Bone Joint Surg Am, 2013, 95(12):e83.
[22] Lizaur-Utrilla A, Sanz-Reig J, Trigueros-Rentero M A.Greater satisfaction in older patients with a mobile-bearing compared with fixed-bearing total knee arthroplasty[J].J Arthroplasty, 2012, 27(2):207-2012.
[23] Kim Y H, Park J W, Kim J S. Comparison of high-flexion fixed-bearing and high-flexion mobile-bearing total knee arthroplasties-a prospective randomized study[J].J Arthroplasty, 2018,33(1):130-135.
[24] 王国栋,郭艾, 强华, 等.活动平台人工膝关节置换术后的中期随访[J]. 中国组织工程研究, 2014, 18(26):4101-4107
[25] Brander V A, Stulberg S D, Adams A D, et al. Predicting total knee replacement pain:a prospective, observational study[J].Clin Orthop Relat Res, 2003(416):27-36.
[26] Forsythe M E, Dunbar M J, Hennigar A W, et al.Prospective relation between catastrophizing and residual pain following knee arthroplasty:two-year follow-up[J].Pain Res Manag,2008, 13(4):335-341.
[27] Lee G W, Lee S M, Jang S J, et al.The efficacy of patellar decompression for improving anterior knee pain following total knee arthroplasty without patellar resurfacing[J].Arch Orthop Trauma Surg, 2013,133(4):561-567.
[28] Pavlou G, Meyer C, Leonidou A,et al.Patellar resurfacing in total knee arthroplasty:does design matter? A meta-analysis of 7075cases[J].J Bone Joint Surg Am, 2011,93(14):1301-1309.
[29] Daniilidis K, Vogt B, Gosheger G, et al.Patellar resurfacing as a second stage procedure for persistent anterior knee pain after primary total knee arthroplasty[J].Int Orthop, 2012, 36(6):1181-1183.
[30] Muoneke H E, Khan A M, Giannikas K A, et al.Secondary resurfacing of the patella for persistent anterior knee pain after primary knee arthroplasty[J].J Bone Joint Surg Br, 2003, 85(5):675-678.
[31] Breugem S J, van Ooij B, Haverkamp D,et al.No difference in anterior knee pain between a fixed and a mobile posterior stabilized total knee arthroplasty after 7.9 years[J].Knee Surg Sports Traumatol Arthrosc,2014, 22(3):509-516.
[32] Van Jonbergen H P, Reuver J M, Mutsaerts E L, et al.Determinants of anterior knee pain following total knee replacement:a systematic review[J].Knee Surg Sports Traumatol Arthrosc,2014,22(3):478-499.
[33] Maculé F, Sastre S, Lasurt S, et al.Hoffa's fat pad resection in total knee arthroplasty[J].Acta Orthop Belg, 2005, 71(6):714-717.