在全膝关节置换术中保留和切除髌下脂肪垫对髌腱长度的影响

Influence on patellar tendon length after total knee arthroplasty with and without preservation of the infrapatellar fat pad

目的研究在初次全膝关节置换术中，保留和切除髌下脂肪垫对髌腱长度的影响。方法将67例骨性关节炎患者（99膝），分为A、B两组。A组为保留髌下脂肪垫组（51膝），B组为切除髌下脂肪垫组（48膝）。拍摄膝关节X—ray侧位片：患者仰卧位，半屈膝（〉30°），并确认髌腱为紧张状态。于膝关节侧位片上定位髌骨下极髌腱附丽点和胫骨结节上方凹陷，测量其两点直线长度，即为髌腱长度。测量术前及术后随访时髌腱的长度。结果A组术前及术后随访时髌腱的长度差异无统计学意义，B组术前及术后随访时髌腱的长度差异有统计学意义（t检验，P=0．0083）。结论在全膝关节置换术中，切除髌下脂肪垫是引起髌腱短缩的重要因素之一，已成为全膝关节置换术后的潜在的、难以察觉的并发症。

Objective Our aim was to assess whether there was any significant difference in patellar tendon length after total knee arthroplasty with and without preservation of the infrapatellar fat pad. Methods 99 primary total knee arthroplasties （67 patients ） of osteoarthritis were divided into two groups（A and B）after a mean of 14.6 momths follow - up . Group A（51 cases）was infrapatellar fat pad preserved. Group B（48 cases）was intrapate｜lar fat pad excised. Apparent patellar tendon length was meas- ured on its deep surface between the inferior pole of the patella and notch just above the tibial tuberosity on preoperative and postoperative lateral radiographs which were taken supine with the knee in a semiflexed position of at least 30°of flexion,thus ensuring the patellar tendon was tightened. Results After a mean of 14.6 months folloe - up there was no significant pateUar tendon shortening in Group A（ intrapatellar fat pad preserved）（P = 0. 5913 ）and a significant change in Group B （ intrapatellar fat pad excised）（ P = 0. 0083）. Conclusion As the etiology of patellar tendon shortening is thought to be multifactorial, we believe our finding of significant patellar tendon shortening with infrapatellar fat pad excision is important in identifying one such factor of a potentially debilitating complication of knee arthroplasty.