摘要
目的探讨髌骨置换时髌骨假体内置对髌股关节运动轨迹的影响。方法2001年9月～2002年3月48例(75膝)行全膝关节置换患者,采用髌骨假体内置的方法置换髌骨,并在术中髌骨置换前后测试髌股关节运动轨迹,术后对患者进行随访。观察髌骨假体安放位置对髌股关节运动轨迹及术后关节功能的影响。结果75膝术中胫骨、股骨截骨完成并安装试模后测试髌股关节运动轨迹,69膝可达到“nothumbtest”,髌骨内置2～5mm后再次测试仍全部达到“nothumbtest”;余6膝未达到“nothumbtest”,经髌骨内置4～8mm后5膝达到,1膝经髌外侧支持带松解最终实现“nothumbtest”。术后经12～18个月随访,膝关节活动度平均为116.5°(95°～125°)。无一例出现髌骨脱位、半脱位、髌骨坏死、髌骨骨折、髌腱撕脱、髌骨不稳以及皮肤坏死等并发症。结论在全膝关节置换术中,髌骨假体内置可有效地改善髌股关节运动轨迹,减少对髌外侧支持带松解的需求,降低髌骨相关的并发症。
Objective To investigate the effect of medialization of the patella component on patel-lar-femoral track and clinic result in patellar resurfacing arthroplasty in Chinese adults.Methods From September2001to March2002,patellar-femoral track of medialized patella component in total75consecu-tive total knee arthroplasties were checked with'no thumb test'sign during patellar resurfacing as well as af-ter patellar resurfacing.The patients consisted of 8males(14knees)and40females(61knees).The average age of the patients was66.2years old(ranging from62to79years old).The preoperative diagnosis of the knees were osteoarthritis96%,rheumatoid arthritis4%.There were65varus knees,9nomal knees and1val-gus knee.Eight knees had patellar subluxation or bad patellar-femoral track before arthroplasty.Results Patellar-femoral track were checked with'no thumb test'sign after putting femoral and tibial tray before patellar resurfacing,69of 75knees could reach'no thumb test'.After resurfacing and medialization of patella com ponent by2to5mm,all69knees could still reach'no thumb test'.But 6knees were ineffectual.After resur facing and medialization of patella component by4to8mm,5of the6knees could reach'no thumb test',the remained one reached'no thumb test'and was of 15°valgus after lateral release.Average flexion of total75knees was108.6°(from90°to115°)two weeks after operation,and increased to116.5°(from95°to125°)after an average follow-up of 15months,ranging from12to18months.No case had patellar fracture insta bility and patellar subluxation.Conclusion Medialization of the patella component in total knee arthro plasty can improve patellar-femoral track,reduce requirement of release of patellar lateral retinac-ulum,decrease patellar-femoral joint complication and increase survival ship of prosthesis.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2003年第6期358-360,共3页
Chinese Journal of Orthopaedics
