南京医科大学学报（自然科学版）2026，Vol.46Issue(3)：435-443,9.DOI:10.7655/NYDXBNSN251473
影响保留髌骨的全膝关节置换术后膝前痛发生的多因素分析
Factors influencing the onset of anterior knee pain after total knee arthroplasty without patellar resurfacing:a multivariate analysis
摘要
Abstract
Objective:To analyze the factors influencing the occurrence of anterior knee pain after total knee arthroplasty(TKA)without patellar resurfacing.Methods:A retrospective analysis was conducted on 2 027 patients who underwent TKA without patellar resurfacing in the Department of Orthopaedics,at the First Affiliated Hospital of Nanjing Medical University,between September 2020 and May 2025.Based on the presence of postoperative anterior knee pain,patients were divided into a non-AKP group(1 886 cases)and an AKP group(141 cases).Preoperative and postoperative radiographic parameters were measured and compared between the groups.Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for anterior knee pain.Results:There were no statistically significant differences in sex,age,or body mass index(BMI)between the two groups(all P>0.05).There were statistically significant differences between the two groups in the preoperative patellar tilt angle,preoperative patellar shift,preoperative patellar morphology,postoperative patellar tilt angle,postoperative patellar shift,postoperative patellar morphology,and patellofemoral overstuffing(all P<0.05).The preoperative patellar thickness,preoperative patellar height,preoperative HKA angle,postoperative patellar thickness,postoperative patellar height,and postoperative HKA angle showed no significant differences between the two groups(all P>0.05).Multivariate analysis identified postoperative patellar tilt angle,postoperative patellar shift,patellofemoral overstuffing,and patellar height as independent risk factors(all P<0.05).Mediation analysis demonstrated that patellar morphology had no direct effect on anterior knee pain,and its influence was completely mediated by patellar tilt angle and patellar shift.Conclusion:Increased postoperative patellar tilt angle,increased postoperative patellar shift,postoperative patella baja,and patellofemoral overstuffing are independent risk factors for anterior knee pain after TKA without patellar resurfacing.Mediation analysis further revealed that the effect of patellar morphology on anterior knee pain is entirely mediated by patellar tilt angle and patellar shift.关键词
关节置换术/膝前痛/髌股关节/危险因素/Logistic模型Key words
arthroplasty/anterior knee pain/patellofemoral joint/risk factors/logistic models分类
医药卫生引用本文复制引用
陈有泉,鲍星安,黄易,杨辉,乐林丰,刘锋..影响保留髌骨的全膝关节置换术后膝前痛发生的多因素分析[J].南京医科大学学报（自然科学版）,2026,46(3):435-443,9.基金项目
江苏省人民医院临床能力提升工程(JSPH-NB-2022-8) （JSPH-NB-2022-8）
