关节置换前后髌骨高度对膝关节功能的影响

目的:研究全膝关节置换术前、术后Insall-Salvati指数和改良Insall-Salvati指数与术后膝关节活动度的关系。方法:采用HSS评分系统对患者全膝关节置换术后半年至一年的关节功能、活动度、肌力、屈曲畸形、稳定性等进行评价。测量81例(106膝)患者术前、术后X线片Insall-salvati指数及改良Insall-salvati指数。结果:术后HSS评分为(89±10)分,术前Insall-salvati指数及改良Insall-salvati指数分别为(1.00±0.13)、(1.61±0.21),术后Insall-salvati指数及改良Insall-salvati指数分别为(0.94±0.19)、(1.67±0.34)。关节置换术后Insall-salvati指数较置换前显著降低(P0.05),改良Insall-salvati指数显著提高(P0.05)。术后低位髌骨组(Insall-salvati指数0.8)HSS评分、活动度和屈曲畸形分值均较正常髌骨组(0.8Insall-salvati指数1.5)显著降低(P0.05)(P0.05)。高位髌骨组(Insall-salvati指数1.5)和正常髌骨组各项评分均无显著差异(P0.05)。术前改良Insall-salvati指数小于1.8的患者术后膝关节HSS评分、功能、活动度、肌力、屈曲畸形、稳定性显著高于大于1.8的患者(P0.05)。结论:术前改良Insall-salvati指数和术后Insall-salvati指数可作为评价术后膝关节功能的参考指标。术前、术后的膝关节高度均会影响术后关节功能,全膝关节置换术中精确截骨对术后关节功能十分重要。

The Effects of Preoperative and Postoperative Patellar Position on Postoperative Knee Joint Function

Objective:To study the relationship between preoperative and postoperative Insall-Salvati ratio, modified Insall-Salvati ratio and postoperative knee joint function.Methods:The Hospital for Special Surgery (HSS) score was used to evaluate the joint function, activity, myodynamia, flexion deformity, stability, etc between half a year and one year after total knee replacement. The preoperative and postoperative Insall-Salvati ratio, modified Insall-Salvati ratio of 81 patients (106 knee joint) on X ray were measured.Results:The postoperative HSS score was (89± 10). The preoperative Insall-Salvati ratio and modified Insall-Salvati ratio were (1.00± 0.13) and (1.61± 0.21), while the postoperative Insall-Salvati ratio and modified Insall-Salvati ratio were (0.94± 0.19) and (1.67± 0.34). The postoperative Insall-Salvati ratio significantly increased as compared with the preoperative Insall-Salvati ratio (P<0.05), while the postoperative modified Insall-Salvati ratio significantly decreased as compared with the preoperative modified Insall-Salvati ratio(P<0. 05). The postoperative HSS score, range of motion score and flexion contracture score significantly decreased in postoperative patella baja (Insall-salvati ratio<0.8) when compared with that in postoperative normal patella (0.81.5) and normal patella(P>0.05). The postoperative HSS score, range of motion score, stability score, functional score, quadriceps strength score, flexion contracture score of patients whose preoperative modified Insall-salvati ratio were higher than 1.8 significantly increased, when compared with that of patients whose preoperative modified Insall-salvati ratio were lower than 1.8 (P<0.05).Conclusion:Preoperative modified Insall-salvati ratio and postoperative Insall-salvati ratio could be considered as reference index of postoperative knee joint function. Both preoperative and postoperative patellar position affected the postoperative knee joint function. So exact resection in total knee arthroplasty was very important.