Page 127 - 《南京医科大学学报（自然科学版）》2026年第3期

第46卷第3期 南京医科大学学报（自然科学版）
2026年3月 Journal of Nanjing Medical University（Natural Sciences） ·435 ·

·临床研究·

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

陈有泉 ，鲍星安 ，黄 易 ，杨 辉 ，乐林丰 ，刘 锋 1*
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南京医科大学第一附属医院骨科，江苏 南京 210029；苏州大学附属医院骨科，江苏 苏州 215006
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［摘 要］ 目的：探讨影响保留髌骨的全膝关节置换（total knee arthroplasty，TKA）术后膝前痛发生的因素。方法：回顾性分析
2020年9月—2025年5月于南京医科大学第一附属医院骨科接受保留髌骨的TKA患者2 027例，根据术后是否发生膝前痛，将
患者分为无膝前痛组（1 886例）和有膝前痛组（141例）。测量并比较两组患者术前与术后的影像学指标。采用单因素分析及
多因素Logistic回归分析确定影响膝前痛的独立危险因素。结果：两组患者性别、年龄、体重指数的差异均无统计学意义（P >
0.05）。两组患者术前髌骨倾斜角、术前髌骨移位、术前髌骨形态、术后髌骨倾斜角、术后髌骨移位、术后髌骨形态、髌股关节充
填距离差异有统计学意义（P < 0.05）。术前髌骨厚度、术前髌骨高度、术前髋⁃膝⁃踝（hip⁃knee⁃ankle，HKA）角、术后髌骨厚度、
术后髌骨高度、术后HKA角差异无统计学意义（P > 0.05）。多因素分析显示，术后髌骨倾斜角、术后髌骨移位、髌股关节充填
距离、髌骨高度具有统计学意义（P < 0.05）。中介效应分析显示，髌骨形态对膝前痛无直接效应，其影响完全由髌骨倾斜角与
髌骨移位两个中介变量产生。结论：术后倾斜角增大、术后髌骨移位增加、术后低位髌骨和髌骨过度充填为保留髌骨的TKA
术后膝前痛发生的独立危险因素。中介效应分析进一步表明，髌骨形态对膝前痛的影响完全由髌骨倾斜角与髌骨移位介导。
［关键词］ 关节置换术；膝前痛；髌股关节；危险因素；Logistic模型
［中图分类号］ R584 ［文献标志码］ A ［文章编号］ 1007⁃4368（2026）03⁃435⁃09
doi：10.7655/NYDXBNSN251473

Factors influencing the onset of anterior knee pain after total knee arthroplasty without
patellar resurfacing：a multivariate analysis

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CHEN Youquan ，BAO Xing’an ，HUANG Yi ，YANG Hui ，LE Linfeng ，LIU Feng 1*
Department of Orthopaedics，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029；
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2 Department of Orthopedics，Affiliated Hospital of Soochow University，Suzhou 215006，China
［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，

［基金项目］ 江苏省人民医院临床能力提升工程（JSPH⁃NB⁃2022⁃8）
通信作者（Corresponding author），E⁃mail：njliuf@163.com（ORCID：0000⁃0002⁃3602⁃3840）
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