全膝关节置换术中不置换髌骨，行吗？
Long-term Follow-up of Patellar Nonresurfacing in Total Knee Arthroplasty
全膝关节置换术中不置换髌骨的长期随访结果
译者：马云青
Background: We aimed to confirm the long-term effect of patellar nonresurfacing (patellar decompression) in preventing anterior knee pain after total knee arthroplasty (TKA) and to investigate the possible complications.
背景: 文章旨在证实术中髌骨不置换(单纯行髌骨减压术)预防全膝关节置换术后膝关节前方疼痛的远期效果，并探讨其可能的并发症。
Methods: Among patients who underwent primary TKA after being diagnosed as having advanced osteoarthritis (Kellgren-Lawrence grade 4) at our institution from January 2004 to December 2010, 121 patients who were followed up for more than 7 years were included in this study. Patients who underwent TKA with and without patellar decompression were classified as the study group and control group, respectively. A clinical knee rating score was used to compare the postoperative clinical outcomes between groups. To identify complications after patellar decompression, simple radiographs (weight-bearing anteroposterior and lateral views, patella in 30° and 45° axial views, and whole scanogram) were taken during follow-up.
方法: 选择2004年1月至2010年12月确诊为晚期骨关节炎(Kellgren-Lawrence 4级)的初次TKA 患者共121例，随访7年以上。接受髌骨减压和非髌骨减压的患者分为研究组和对照组。膝关节临床评分系统用于比较两组术后临床疗效。为了确定髌骨减压术后的并发症，随访时行 x 线片检查包括：膝关节负重前后、侧位X线片、髌骨屈膝30 ° 和45 ° 轴位片和下肢全长片。
Results: There were no complications such as patellar fracture, osteonecrosis, and subluxation. At 2 years after surgery, the prevalence of anterior knee pain was 12.7% and 18.0% in the study group and control group, respectively (p = 0.42), and the number of patients with patellofemoral osteoarthritis grade II or over was lower in the study group (p = 0.03). At 7 years after surgery, the prevalence of anterior knee pain was 18.3% and 24.0% in the study group and control group, respectively (p = 0.45), and there was no statistically significant intergroup difference in the number of patients with patellofemoral osteoarthritis grade II or over (p = 0.11).
结果: 术后无髌骨骨折、骨坏死、半脱位等并发症发生。术后2年，研究组和对照组膝关节前方疼痛发生率分别为12.7% 和18.0% (p = 0.42)，术后研究组髌股关节炎II级及以上患者人数低于对照组(p = 0.03)。术后7年，研究组和对照组膝关节前方疼痛发生率分别为18.3% 和24.0% (p = 0.45)，髌股关节炎II级及以上患者人数组间差异无统计学意义(p = 0.11)。
Conclusions: Patellar nonresurfacing TKA reduces anterior knee pain in the early postoperative period. The procedure can be considered a relatively safe option with fewer complications; however, its effectiveness appears to decrease over time.
结论: 髌骨不置换同时行髌骨减压可以减轻TKA术后早期膝前痛。这种手术方式是一种相对安全的选择，并发症较少，但其有效性随着时间的推移而降低。
术中髌骨修整前周围骨赘，清理骨赘后，用3.5mm克氏针平行髌骨纵轴钻孔减压
文献出处：Choi Y, Koo J, Moon SW, Yang Y, Son J. Long-term Follow-up of Patellar Nonresurfacing in Total Knee Arthroplasty. Clin Orthop Surg. 2020 Mar;12(1):49-54. doi: 10.4055/cios.2020.12.1.49. Epub 2020 Feb 13. PMID: 32117538; PMCID: PMC7031425.