摘要膝前痛是全膝关节置换(total knee arthroplasty,TKA)术后最常见的并发症,髌股关节与膝前痛的发生关系密切,因而膝前痛也被称为髌股关节痛.TKA术后膝前痛发生的主要原因是髌股关节填塞和髌骨轨迹异常,而填塞和轨迹异常的出现与TKA改变髌股关节原本的生理解剖形态和Q角相关.这种改变除患者自身遗传因素外,还和假体与生理解剖形态不匹配及手术技巧有关.其中假体不匹配是指假体无法完全匹配不同性别和种族患者的髌股关节解剖差异.在手术技巧方面,髌骨置换与否、髌周去神经化与否、假体类型的选择,以及股骨、髌骨假体的放置位置等都会影响术后膝前痛的发生.上述因素最终可能导致髌股关节面压力异常增大及分布不均,刺激和压迫周围神经而引发膝前痛.因此可以通过设计更符合髌股关节生理形态的假体,及根据患者个体情况应用髌骨置换、髌周去神经化、髌下脂肪垫保留或选择胫骨旋转平台假体等手术技术来减少TKA术后膝前痛的发生,全面提高患者满意度.

abstractsAnterior knee pain continues to be a major problem following total knee arthroplasty (TKA). Patellofemoral joint is closely associated to the occurrence of the anterior knee pain, so it is also called patellofemoral joint pain. Overstuff of patellofemoral joint and patella maltracking are the main factors for anterior part of the post-operative pain. They are resulted from the change of native morphology and Q angle of patellofemoral joint after operation. Instead of non-modifiable patients'congenital and genetic factors, they are mainly related to the improper surgical techniques and the mismatch between prostheses and native patellofemoral morphology. The reason of the mismatch is that the prosthesis is unable to cover all kinds of differences of the patel-lofemoral morphology among races and genders. In addition, some surgical techniques, including patellar replacement, circumpa-tellar denervation, femoral and patellar prostheses location, and the selection of the type of prosthesis, also affect the occurrence of anterior knee pain. The above mentioned factors may eventually lead to excessive and uneven distribution of the patella-femoral loads, which would compress and simulate the peripheral nerves around the joint. Ultimately, they result in the anterior knee pain. Therefore, the following effective strategies could lead to relief anterior knee pain and improve patients overall satisfaction after TKA, including improvements of prostheses design, patellar resurfacing, circumpatellar denervation, infrapatellar fat padpreserva-tion or using mobile-bearing rotating-platform.