全膝关节置换术中保留髌下脂肪垫对膝关节功能恢复的影响

Effect of reserving infrapatellar fat pad on functional recovery of knee joint during total knee arthroplasty

目的探讨全膝关节置换(TKA)术中保留髌下脂肪垫对膝关节功能恢复的影响。方法选取2014年1月至2018年10月合肥市第一人民医院行TKA病人21例(23膝),术中保留完整的髌下脂肪垫。术后随访3个月、6个月和1年,随访内容包括膝关节活动度、膝前痛发生率、美国特种外科医院(HSS)膝关节功能评分、Insall-Salvati比值、髌腱短缩发生率以及术后髌腱损伤发生率。结果手术后3个月(114.21±0.57)°、6个月(118.23±0.77)°和1年(117.26±0.87)°膝关节活动度、HSS膝关节功能评分[(84.88±0.82)、(85.78±0.37)、(86.56±0.66)分]高于术前(87.52±0.36)°和(52.36±0.75)分,差异有统计学意义(P<0.05),膝前痛发生率4.34%,Insall-Salvati比值与术前比较差异无统计学意义(P>0.05),髌腱短缩发生率4.34%,髌腱损伤发生率0。结论全膝关节置换术中保留完整的髌下脂肪垫,可以有效提高术后膝关节活动度、改善膝关节功能,术中对髌腱可以起到保护作用,可以有效防止术后髌腱短缩,降低膝前痛出现的概率。

Objective To investigate the effect of reserving infrapatellar fat pad on the functional recovery of knee joint during total knee arthroplasty(TKA).Methods Twenty-one patients(23 knees)underwent TKA with intact infrapatellar fat pad were selected in the First People’s Hospital of Hefei from January 2014 to October 2018.The follow-up time was 3 months,6 months and 1 year after operation.The follow-up contents included range of motion of knee joint,incidence of anterior knee pain,HSS knee function score,Insall Salvati ratio,incidence of patellar tendon shortening and incidence of postoperative patellar tendon injury.Results The knee range of motion[(114.21±0.57)°,(118.23±0.77)°,(117.26±0.87)°vs.(87.52±0.36)°]and HSS knee function score[(84.88±0.82),(85.78±0.37),(86.56±0.66)vs.(52.36±0.75)]at 3 months,6 months and 1 year after operation were higher than those before operation,and the difference was statistically significant(P<0.05).The incidence of anterior knee pain was 4.34%,and the Insall Salvati ratio had no significant difference(P>0.05).The incidence of patellar tendon shortening was 4.34%,and the incidence of patellar tendon injury was 0.Conclusion Reserving a complete infrapatellar fat pad during total knee arthroplasty can effectively improve the range of motion and function of the knee joint,protect the patellar tendon during the operation,effectively prevent the shortening of the patellar tendon after the operation,and reduce the probability of anterior knee pain.