止血带对全膝关节置换术中股骨远端旋转定位时髌骨轨迹的影响

Objective To explore, the influence of tourniquet application on patellar tracking with using the surgical transepieondylar axis as distal femur alignment in total knee arthroplasty (TKA). Methods From December 2002 to August 2008, 349 cases (526 knees) of primary TKA were performed. There were 124 males and 225 females with an average age of 68 years from 33 to 84 years. A total of 387 knees had varus deformity and 94 had valgus deformity. All of prosthesis were rotating platform with posterior cruciate ligament retaining provided by Gemini MK Ⅱ. All patients underwent anterior medial parapatellar approach. The surgical transepieondylar axis had been principally used as the distal femur alignment. Patellar tracking was checked with no thumb test. For maltracking ones, we prefered to use a single retinacular closing stitch at the superior medial arthrotomy and deflate tourniquets. Patellar tracking was checked again. Finally, later-al retinaeular releases (LRR) had been performed to obtain optimizing patellar tracking. Results Intraoper-atively, no thumb test were positive in 138 knees, including patellar subluxation (vaigus deformity) in 12 knees and patellar inclining (74 of valgns deformity and 52 of varus deformity) in 126 knees. After using a single retinacular closing stitch at the superior medial arthrotomy and deflating tourniquets, no thumb test were positive in 40 knees, including patellar subluxation (valgus deformity) in 8 knees and patellar inclining (29 of valgns deformity) in 32 knees. The total rate of LRR was 7.6% (40/526), the rate of LRR in valgus deformity was 39.4% (37/94) and that in yarns deformity and no deformity was 0.7% (3/432). Conclusion There was significant influence of tourniquet application on patellar tracking during the TKA. We were not falsely correcting patellar tracking problems with using a single retinaeular closing stitch at the superior me-dial arthrotomy anti deflating tourniquets intraoperatively and reducing the rate of LRR.

Influence of tourniquet application on patellar tracking in total knee arthroplasty