全膝关节置换术中保留髌下脂肪垫对髌腱短缩的影响

Effect for preservation of infrapatellar fat pad on patellar tendon shortening in total knee arthroplasty

目的探讨保留髌下脂肪垫在全膝关节置换术中对髌腱短缩的影响。方法将邯郸市第一医院骨科86例(86膝)行全膝关节置换术的骨性关节炎患者按手术方式分为保留组(保留大部分髌下脂肪垫及滑膜)与切除组(切除髌下脂肪垫,选择假体进行置换)各43例。保留组男性13例,女性30例,平均年龄(60.95±5.34)岁。切除组男性15例,女性28例,平均年龄(61.27±5.51)岁。对比两组术前、术后1年HSS膝关节功能评分(疼痛、功能、活动度、肌力、屈膝畸形、稳定性),膝关节活动度(屈膝度、屈曲挛缩),并记录髌腱短缩的发生率、膝前痛发生率及术后并发症发生率。结果保留组髌腱短缩的发生率低于切除组(25.58%vs.46.51%),差异有统计学意义(P=0.043)。两组术后1年疼痛、功能、活动度、肌力、屈膝畸形、稳定性评分均高于术前,差异有统计学意义(P<0.05);组间各项目评分比较差异均无统计学意义(P>0.05)。两组术后1年屈膝度、屈曲挛缩均低于术前,差异有统计学意义(P<0.05);但组间比较差异无统计学意义(P>0.05)。所有患者术后均未发生髌腱损伤。保留组术后1年膝前痛发生率低于切除组(2.33%vs.20.93%),差异有统计学意义(P=0.007)。结论保留与切除髌下脂肪垫用于全膝关节置换术在改善膝关节功能、膝关节活动度方面疗效相当,但前者可明显降低髌腱短缩及膝前痛发生率,且并未增加髌腱损伤风险,临床应用价值较高。

Objective To investigate the effect for preservation of patellar fat pad on patellar tendon shortening in total knee arthroplasty. Methods Totally 86 patients（ 86 knees） undergoing total knee arthroplasty with osteoarthritis in our hospital were divided into observation group（ preserving infrapatellar fat pad） and control group（ resecting infrapatellar fat pad）,with 43 cases in each group. The observation group included 13 males and 30 females,with an average age of（ 60. 95 ± 5. 34） years. The control group included 15 males and 28 females,with an average age of（ 61. 27 ± 5. 51） years. The patellar tendon length,HSS knee function score（ pain,function,activity,strength,flexion deformity,stability） and knee mobility（ flexion,flexion contracture） were compared between the two groups preoperatively and at 1 year after operation. The incidence of patellar tendon shortening,the incidence of anterior knee pain and the incidence of postoperative complications were recorded. Results The incidence of patellar tendon shortening in the observation group was lower than that in the control group（ 25. 58% vs. 46. 51%）,and the difference was statistically significant（ P = 0. 043）. At 1 years after operation,the pain,function,activity,muscle strength,flexion deformity and stability scores in both groups were higher than preoperatively（ P〈0. 05）,but there was no significant difference between the two groups（ P〈0. 05）. The flexion and flexion contracture of the two groups at 1 year after operation were lower than those before operation,and the difference was statistically significant（ P〈0. 05）. But there was no significant difference between the two groups（ P〉0. 05）. No patellar tendon injury occurred in any patient. The incidence of knee pain in the observation group was lower than that in the control group after one year（ 2. 33% vs. 20. 93%）,and the difference was statistically significant（ P = 0. 007）. Conclusion Both prepervation and resection of the patellar fat pad for total knee arthroplasty are effective in improving knee function and knee mobility. But the former can significantly reduce the occurrence of patellar tendon shortening and anterior knee pain,does not increase the risk of patellar tendon injury and has greater clinical application value.