髌股关节炎影响非髌骨置换的TKA后临床和放射学结果么?

2018-09-05    点击量:15 我要说

在线发表于《J Arthroplasty》的一项研究显示,术后2年以上随访非髌骨置换的全膝关节置换患者的临床和影像学结果,与术前髌股关节炎的严重程度无关。即使在晚期髌股关节炎患者中,非髌骨置换的TKA也取得了良好的疗效。

作者通过回顾2010年9月到2015年5月采用Nexgen® LPS/LPS-flex假体完成的全膝关节置换但未置换髌骨的患者,来比较不同严重程度髌股关节炎的全膝关节置换手术,当没有进行髌骨置换时的临床和影像学效果。


(A)髌骨成形前髌骨的大体照片。髌骨周围的骨赘。髌骨外侧关节面变形为凹形。(B)骨赘被移除,凹面被修整平。同时也进行了髌骨周围去神经化。

(A)轻度髌骨关节炎患者的术前髌骨轴位片。(B)髌骨周围的骨赘在全膝关节置换术中被修整。

(A)重度髌骨关节炎患者的术前髌骨轴位片。(B)髌骨周围的骨赘在全膝关节置换术中被修整,外侧关节面修整平,使髌骨适应股骨假体。

研究人员采用Iwano影像学分级系统对474例膝关节的髌股关节炎进行分级,分为轻度组(0-Ⅰ级)和中度至重度组(II-IV级)。临床结果采用特种外科医院评分(HSS),膝关节协会评分(KSS),KSS功能评分,WOMAC评分和Feller评分。随后通过测量髌骨适合角、髌骨倾斜角和髌骨外移进行术后影像学评估。所有患者的临床结果和影像学评估最少随访2年并比较两组的术前和最后一次随访结果。

结果显示,与轻度组(n=208)相比,中重度组(n=266)术前的Feller评分明显低(P=0.030),而其它术后临床和影像学检查结果无明显差异。


原始文献:

Total Knee Arthroplasty With Patellar Retention: TheSeverity of Patellofemoral Osteoarthritis Did Not Affect the Clinical andRadiographic Outcomes

BACKGROUND:

The purpose of this study is to compare the clinical andradiographic outcomes of total knee arthroplasty (TKA) with patellar retentionin accordance with the severity of patellofemoral arthritis.

METHODS:

We retrospectively reviewed patients who underwent TKAwith patellar retention using the NexGen LPS or LPS-flex system betweenSeptember 2010 and May 2015. The radiographic severity of patellofemoralarthritis was categorized according to the Iwano classification system, andsubjects were divided into mild (stage 0-I) and moderate to severe (stageII-IV) groups. Clinical outcomes were evaluated using the Hospital for SpecialSurgery score, Knee Society Score, function score, Western Ontario and McMasterUniversities Osteoarthritis Index, and Feller score. Radiographic outcomes wereassessed using the congruence angle, patellar tilt angle, and lateral patellardisplacement. The minimum follow-up for clinical and radiographic evaluation was2 years. Clinical and radiographic outcomes were compared between the 2 groupspreoperatively and at the time of the last follow-up.

RESULTS:

Four hundred seventy-four knees were enrolled and assignedto mild (n = 208) or moderate to severe (n = 266) groups. The preoperativeFeller score was significantly lower in the moderate to severe group (P =.030), whereas the postoperative clinical and radiographic results did notdiffer significantly between the 2 groups.

CONCLUSION:

Clinical and radiographic outcomes did not differ inaccordance with the severity of patellofemoral arthritis after a minimum 2years of follow-up of patients treated with TKA with patellar retention. Goodoutcomes were obtained with patellar retention in TKA, even in patients withadvanced patellofemoral osteoarthritis.

文献出处:Cho WJ, Bin SI, Kim JM, et al. Total Knee ArthroplastyWith Patellar Retention: The Severity of Patellofemoral Osteoarthritis Did NotAffect the Clinical and Radiographic Outcomes. J Arthroplasty. 2018 Feb 26.pii: S0883-5403(18)30223-7.



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