治疗被忽视的髌骨脱位骨关节炎膝关节的初级全膝关节置换术

Q4 Medicine Medicina Pub Date : 2024-09-13 DOI:10.3390/medicina60091492
Sung Eun Kim, Seong Hwan Kim, Jung-In Lee, Hyuk-Soo Han, Myung Chul Lee, Du Hyun Ro
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引用次数: 0

摘要

背景和目的:存在终末期骨关节炎(OA)的被忽视的髌骨脱位是一种罕见病症,其特点是髌骨仍然侧向脱位而未复位。由于报道的病例很少,最佳治疗方法仍不确定。不过,初级全膝关节置换术(TKA)是一种有效的治疗方法。本研究旨在介绍采用我们的手术技术所取得的临床和放射学效果。材料和方法:对8名髌骨脱位和终末期OA患者的12个膝关节进行了回顾性研究,这些患者均接受了初级TKA手术。手术方法包括传统的 TKA 技术(如内侧髌骨旁关节切开术)和针对被忽视的髌骨脱位的不同病理特征的附加手术(如外侧松解术、内侧夹板术和股四头肌延长术)。临床结果包括患者报告的结果测量(PROMs)(膝关节协会评分和西安大略和麦克马斯特大学骨关节炎指数)和膝关节活动范围(ROM),分别在术前和术后两年进行评估。在术前和最后一次随访检查前,对包括机械股胫骨角和髌骨倾斜角在内的放射学指标进行了评估。此外,还对任何并发症进行了复查。结果:所有 PROMs、膝关节 ROM 和放射学结果(包括机械股胫骨角和髌骨倾斜角)均有明显改善(所有 P < 0.05)。在平均 68 个月的随访中,没有发现需要进行翻修手术的重大并发症,包括髌骨脱位。结论:原位 TKA 是一种有效的手术方法,可纠正终末期 OA 中与被忽视的髌骨脱位相关的各种病变,而无需进行额外的骨性手术。采用病理特异性手术可获得令人满意的临床和放射学效果。
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Primary Total Knee Arthroplasty for Treating Osteoarthritic Knees with Neglected Patellar Dislocation
Background and Objectives: Neglected patellar dislocation in the presence of end-stage osteoarthritis (OA) is a rare condition characterized by the patella remaining laterally dislocated without reduction. Due to the scarcity of reported cases, the optimal management approach is still uncertain. However, primary total knee arthroplasty (TKA) can serve as an effective treatment option. This study aimed to present the clinical and radiological outcomes achieved using our surgical technique. Materials and Methods: A retrospective review of 12 knees in 8 patients with neglected patellar dislocation and end-stage OA who underwent primary TKA was conducted. The surgical procedure involved conventional TKA techniques (e.g., medial parapatellar arthrotomy) and additional procedures specific to the individual pathologies of neglected patellar dislocation (e.g., lateral release, medial plication, and quadriceps lengthening). Clinical outcomes, including patient-reported outcome measures (PROMs) (Knee Society Scores and the Western Ontario and McMaster Universities Osteoarthritis Index) and knee range of motion (ROM), were assessed preoperatively and two years postoperatively. Radiological measures including mechanical femorotibial angle and patellar tilt angle were assessed preoperatively and until the last follow-up examinations. Any complications were also reviewed. Results: There were significant improvements in all PROMs, knee ROM, and radiological outcomes, including mechanical femorotibial angle and patellar tilt angle (all p < 0.05). At a mean follow-up of 68 months, no major complications requiring revision surgery, including patellar dislocation, were reported. Conclusions: Primary TKA is an effective procedure for correcting various pathologies associated with neglected patellar dislocation in end-stage OA without necessitating additional bony procedures. Satisfactory clinical and radiological outcomes can be expected using pathology-specific procedures.
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来源期刊
Medicina
Medicina Medicine-Medicine (all)
CiteScore
0.10
自引率
0.00%
发文量
66
审稿时长
24 weeks
期刊介绍: Publicada con el apoyo del Ministerio de Ciencia, Tecnología e Innovación Productiva. Medicina no tiene propósitos comerciales. El objeto de su creación ha sido propender al adelanto de la medicina argentina. Los beneficios que pudieran obtenerse serán aplicados exclusivamente a ese fin.
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