全膝關節置換術股骨前髁截骨量對膝關節活動度的影響

王傳寶 郜玉忠 王中元 崔宇騰 鄒智

[摘要] 目的 探討全膝關節置換術中股骨前髁截骨量與股骨前髁側假體的差異對術后膝關節活動度的影響。 方法 收集2018年6月至2019年9月在錦州醫科大學附屬第一醫院住院行全膝關節置換術的膝關節骨性關節炎患者共計62例。術中測量股骨前髁截骨骨塊最高處和所用鋸片的厚度，定義T=股骨前髁截骨骨塊最高處厚度+鋸片厚度，根據T將患者分為A（T<8 mm）14例、B（8 mm≤T≤10 mm）32例、C（T>10 mm）16例三組，收集三組患者手術前后HSS評分、Melbourne髕股關節評分、ROM、膝關節正側位資料并進行統計學分析。 結果? 62例患者得到良好的隨訪，隨訪時間12個月。三組患者術后HSS評分、Melbourne髕股關節評分、ROM均優于術前，差異有統計學意義（P<0.05），而術前與術后的HSS、ROM的組間差異并無統計學意義（P>0.05）。A組與B、C組的術后Melbourne評分差異有統計學意義（P<0.05），B、C組間的術后Melbourne評分差異沒有統計學意義（P>0.05）。 結論 全膝關節置換術能夠改善終末期膝關節骨性關節炎患者的功能障礙、提高生活質量。術中股骨前髁截骨量與假體前髁厚度之間的差異對膝關節活動度無臨床意義，對髕股關節功能有統計學意義影響。

[關鍵詞] 全膝關節置換術;膝關節骨性關節炎;髕股關節;活動度

[中圖分類號] R687.4? ? ? ? ? [文獻標識碼] B? ? ? ? ? [文章編號] 1673-9701（2021）24-0090-04

Effect of osteotomy of anterior femoral condyle on range of motion of knee joint after total knee arthroplasty

WANG Chuanbao1， 2? ?GAO Yuzhong2? ?WANG Zhongyuan1， 2? ?CUI Yuteng1， 2? ?ZOU Zhi1， 2

1.Jinzhou Medical University，Jinzhou? 121000，China;2.Department of Joint Surgery of the First Affiliated Hospital of Jinzhou Medical University，Jinzhou? ?121000，China

[Abstract] Objective? To investigate the effect of? of the difference between the volume of the intraoperatively removed anterior femoral condyle and prosthetic anterior femoral condyle on the range of motion of knee joint after total knee arthroplasty. Methods A total of 62 patients with knee osteoarthritis who underwent total knee arthroplasty in the department of joint surgery of the first affiliated Hospital of JinZhou Medical University from June 2018 to September 2019 were collected. The highest depth of the removed femoral anterior condyle and the thickness of sawblade used were measured intraoperatively， and T was defined as the highest depth of the removed femoral anterior condyle+sawblade thickness.Based on the T values， the patients were divided into three groups： A （T<8 mm） Fourteen patients， B （8 mm≤T≤10 mm）thirty-two patients， C （T>10 mm） sixteen patients.The HSS scores、Melbourne scores、X-ray of the Knee and rang of motion were evaluated preoperative and postoperative，and the data for statistical analysis. Results A total of 62 patients were followed up well;with an average follow-up 12 months.The follow-up results show statistically significant differences were found in the HSS scores、Melbourne scores and rang of motion of postoperative were better than preoperative in the three groups（P<0.05）， and the HSS scores、Melbourne scores and rang of motion among the three groups show no statistically significant differences before and after the surgeries（P>0.05）. The Melbourne scores of the patellofemoral joints after the surgeries in group B and C were statistically different from those in group A（P<0.05） and no statistically different between group B and C. Conclusion Total knee arthroplasty can improve the knee dysfunction and quality of life of patients with knee osteoarthritis. The volumes of intraoperatively removed anterior femoral condyle and the thickness of prosthetic anterior condyle present no statistical effects on knee joint mobility，but have statistically significant effects on the functions of the patellofemoral joint.