收稿日期: 2016-06-24
网络出版日期: 2017-04-27
Treatment strategy and effect of maltracking of patellofemoral joints in total knee arthroplasty
Received date: 2016-06-24
Online published: 2017-04-27
目的 总结人工全膝关节置换（total knee arthroplasty，TKA）术中，纠正髌股关节轨迹不良的方法及效果。 方法 2012年6月-2014 年12 月，对52例58膝TKA术中出现髌骨向外侧脱位倾向髌股关节轨迹不良的患者，针对发生原因，通过单纯调整髌骨内、外侧支持带张力，髌骨修整成形或调整胫骨假体位置等方法，或者联合应用上述两种或两种以上方法进行纠正。 结果 术中无拇指试验髌股关节轨迹恢复正常，术后髌骨未出现向外脱位倾向。术后切口均Ⅰ期愈合，2例因外翻明显，术中外侧支持带松解范围较大，术后出现关节积血，经对症处理后好转，无其他并发症发生。所有患者术后均获随访，随访时间 17-47个月，平均32个月。膝关节内、外翻畸形均获得矫正，4例残留 5-10°(平均8°）左右的屈曲畸形。随访末期KSS评分78-89分，平均84分，膝关节KSS功能评分为82-91分，平均86分。术后至随访期末X线片均显示人工关节位置正常，无松动及感染迹象。 结论 TKA术中出现髌股关节轨迹不良时，通过单纯调整髌骨内、外侧支持带张力，髌骨修整成形或调整胫骨假体等方法，或者联合应用上述两种或两种以上方法等进行调整，是处理髌股轨迹不良的有效方法，有利于术后膝关节的功能恢复。
黄媛霞 , 段永壮 , 王利民 , 徐海斌 . 人工全膝关节置换术中髌股关节轨迹不良的处理策略及疗效[J]. 中国临床解剖学杂志, 2017 , 35(2) : 220 -223 . DOI: 10.13418/j.issn.1001-165x.2017.02.021
Objective To summarize the effect and treatment methods in correcting the maltracking of patellofemoral joints in the total knee arthroplasty (TKA). Methods From June 2012 to December 2014, in 52 patellofemoral maltracking patients (58 knees with TKA ) with patella in lateral dislocation propensity, we used the methods of adjusting the tension between lateral retinaculum and medial retinaculum of patella, patella forming or adjusting the position of the tibial prosthesis properly, or employed two or three methods mentioned above,to correct the maltracking of patellofemoral joints when the TKA was conducted. Results No thumb test was negative in operation, and there was no outward dislocation of the patella after operation. Incisions healed by first intention. in 2 cases, hemarthrosis occurred due to larger-range intraoperative lateral support release in order to correct apparent valgus, which was then managed and relieved with the symptomatic approach. No other complications occurred. All patients were followed up for 17~47 months (32 months on average). Genu valgum or genu varum was not found in all cases, Flexion deformity of knee joints with 5~10° (8°on average) was found in 4 cases. At the end of follow-up, KSS score was 78~89 points, with an average of 84 points, and KSS knee function score was 82~91 points, with an average of 86 points. The X-ray films from the very beginning after surgery to the end of follow-up showed the prosthesis was in a normal position with no signs of loosening or infection. Conclusion In order to correct the maltracking of patellofemoral joints in TKA, releasing lateral retinaculum and tightening medial retinaculum of patella, patella forming and dressing , adjusting the position of the tibial prothesis properly, or employing the two or three kinds of methods mentioned above were efficient methods and beneficial to the recovery of knee joint function after operation.
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