全膝关节表面置换术后髌骨下移-第三军医大学学报.doc

初次全膝关节表面置换术后低位髌骨的探讨 张建兵 陈百成 王飞 孙然 河北医科大学第三医院骨科 摘要:目的:分析研究初次全膝关节表面置换术后并发症--髌骨低位的发生机制，为减少其在初次全膝关节表面置换术中的发生率提供理论基础。方法 回顾性研究2003年7月—2008年1月间共78例85膝行初次全膝关节表面置换术病例，我们把insall-salvati指数大于0.8和关节线抬高4mm定义为有临床意义。按照HSS膝关节评分以75分为标准将病例分成两组，观察高分组和低分组术后低位髌骨发生的情况，应用Wilcoxon秩和检验方法进行比较，并对术前两组的评分进行比较。将术前和术后膝关节X线片对照，应用insall-salvati法测量髌骨的高度, 并利用Hofmann 方法来测量关节线的位置变化。运用Logistic回归分析的方法分析低位髌骨的发生和insall-salvati指数及关节线变化的相关性 结果 高分组59膝，未发现低位髌骨病例，低分组26膝，其中23膝发生不同程度的髌骨低位,其中6例insall-salvati指数1.1±0.1，17例关节线上移7±2.3mm。应用Logistic回归分析结果显示低位髌骨的发生与insall-salvati指数和关节线的上移有统计学意义。结论 初次全膝表面置换术后，髌骨下移的发生是由于胫骨聚已烯垫的厚度大于截骨的厚度即关节线上移和髌韧带的挛缩引起的。因此在初次全膝关节表面置换术中我们要最大程度的恢复原有的膝关节线位置，并加强早期的膝关节功能锻炼,以尽快恢复膝关节的活动度防止髌韧带的挛缩。 关键词 膝关节; 成形术 ; 髌骨; 并发症 Analysis of patellar baja after primary total knee arthoplasty zhangJianBing ChenBaiCheng WangFei SunRan The third hospital ,HeBei medical university shijiazhuang 050051 Correspondence： ChenBaiCheng : e-mail:chenbch@ Abstract:objectiveTo investigate the reasons that patella baja occured after primary total knee arthoplasty(TKA), we found basic theories for a lower incidence of patella baja after primary TKA .method we retrospectively studied 78cases 85 primary TKA knees ,which were evaluated promaters and compared preoperative with postoperative in radiology. Insall-salvati index was indicated to measure the height of patella and Hofmann＇s procedure to measure the variation of the joint line.we recognized such an clinical positive sign as the value of insall-salvati index＞ 0.8 and proximally transfering joint line ＞4mm . in mean term of follow up ,subjects was divided to two groups according to HSS .the two groups took 75 score as a sorting baseline.we evaluated the patellar baja knees in the two groups, that was compared by Wilcoxon rank sum test with HSS score .furthermore the preoperative comparison was necessary. Logistic regression was indicate to analyze the correlation of patellar baja with the insall-salvati index and the proximally transf