保留或切除髌下脂肪垫对全膝置换术后早期疗效及髌腱长度影响的随机研究

Patellar tendon length and clinical outcomes after preservation or complete excision of the infrapatellar fat pad in total knee arthroplasty： a randomized controlled trial

目的前瞻性比较保留与完全切除髌下脂肪垫（infrapatellar fat pad，IPFP）对全膝关节置换（totalknee arthroplasty，TKA）术后早期临床结果的影响。方法收集2014年6月至2015年8月100例（100膝）接受单侧TKA的膝内翻骨性关节炎患者资料，男16例，女78例，年龄48-75岁，平均62．37岁。将100例随机分为IPFP保留组与切除组，每组50膝。术中保留组仅切除IPFP表层滑膜组织，切除组则于伸膝位完全切除IPFP。以术后1年作为终末随访的时间节点，比较两组术后1年的临床效果。结果本组100例中共94例获得完整资料随访，其中保留组46例、切除组48例；两组全部病例均未发生术中髌腱损伤及术后伤口并发症。术后1周切除组髌腱长度为（40．35±6．05）mm，保留组为（40．56±6．17）mm；术后1年切除组（36．18±7．09）mm，保留组（38．75±6．23）mm，组间和组内比较的差异均无统计学意义。但术后1年切除组的髌腱短缩程度（-4．18±3．52）mm明显大于保留组（-1．81±2．08）mm，差异有统计学意义。术后1年保留组膝前痛评分（0．93±1．40）分，切除组（2．42±2．19）分，有临床意义的膝前痛比例（2．2％VS．18．8％），均具有统计学意义。两组术后1年的美国膝关节协会评分（Knee Societvscore，KSS）、屈膝度、屈曲挛缩程度、患者满意度评分及满意率的差异均无统计学意义。结论IPFP完全切除可导致TKA术后1年明显的髌腱短缩和更高的膝前痛发生概率，保留IPFP并未增加髌腱损伤风险，因此应尽量保留完整的IPFP组织。

Objective To compare the effect of preservation or complete excision of infrapatellar fat pad （IPFP） on clini- cal outcomes after total knee arthroplasty （TKA） at one year follow-up. Methods We randomized 100 patients （100 knees） undergoing TKA into two groups from June 2014 to August 2015, 16 male and 78 female, with the average of 62.37 years old （range from 48 to 75） . In excision group, 50 patients underwent TKA with complete IPFP excision and in preservation group, 50 patients received TKA without IPFP excision. We compared the outcome at postoperative 1 year between the two groups. Wound complication rate and patellar tendon injury rate were also evaluated. Results Complete follow-up data were available on 94 patients （46 in preservation group and 48 in excision group）. There were no intraoperative patellar tendon injury and postoperative wound complication cases. The patellar tendon length of excision group and preservation group at 1 week was （40.35±6.05） mm and （40.56± 6.17） ram, and at 1 year were （36.18±7.09） mm and （38.75±6.23） ram, there were no statistical differences between the two groups. The patellar tendon shortening at postoperative 1 year in excision group was （-4.18± 3.52） ram, more than preservation group which was （-1.81±2.08） mm, and there was statistically significant difference between the two groups. One year postoperatively, the anterior knee pain score in preservation group 2.42±2.19 was lower than excision group excision group 0.93±1.40, and anterior knee pain rate was 2.2% and 18.8% in each group, the difference were all statistically significant. The Knee Society （KS） scores , knee flexion, flexion contraeture, patient satisfaction score, and patient satisfaction rate had no statistieal differences between the two groups. Conclusion Complete resection of IPFP results in a significant patellar tendon shortening and a higher probability of occurrence of knee pain after 1 year of TKA. Retention of IPFP did not increase the risk of patellar tendon injury and shouht there- fore be kept as much as possible for complete IPFP.