全膝置换术后的髌腱短缩及其临床影响

目的研究全膝置换(totalkneearthroplasty,TKA)术后的髌腱长度变化,置换髌骨对髌腱长度的影响,髌腱长度变化与术后膝关节活动度的关系。方法2002年5月~2003年12月对49例55个关节行初次全膝置换手术。包括48例骨关节炎、7例类风湿性关节炎,其中7例做了外侧支持带松解,测量术前的髌腱长度及术后1年的髌腱长度和膝关节活动度,按是否置换髌骨分成两组,对数据进行组间和组内统计学分析。结果术后1年,髌腱发生有统计学意义的短缩(P<0·01)。在短缩大于10%的发生率上,换与不换髌骨组没有统计学意义的差别(P>0·05)。髌腱短缩和关节活动度呈负相关(P<0·01)。结论全膝置换术后存在髌腱短缩的并发症。置换髌骨对髌腱短缩没有影响。髌腱短缩可能是导致术后活动度损失的原因之一。

Shortening of Patellar Tendon and Its Clinical Influence after Total Knee Arthroplasty

Objective To investigate the change in the length of patellar tendon after total knee arthroplasty,the effect of patella resurfacing on the tendon length and the correlation between the length change and the range of motion.Methods The primary total knee arthroplasty were performed on fifty-five knees of forty-nine patients from May 2002 to December 2003 by one group of surgeons.The osteoarthritis was diagnosed in 48 knees and the rheumatoid arthritis in 7 knees.The lateral retinaculum release was performed in 7 knees additionally.The length of patellar tendon was measured before and one year after operation and the range of motion were recorded one year after the operation.All the knees were divided into two groups according to whether the patella was resurfaced or not.The statistical analysis was made within and between groups.Results One year after operation,the patellar tendon had significant shortening (P<0.01).Nevertheless,there was no significant difference in the incidence of more than 10% shortening between the patella resurfacing group and the no patella resurfacing group (P>0.05).A negative correlation was found between shortening of patellar tendon and the postoperative range of motion (P<0.01).Conclusion The shortening of patellar tendon may occur after total knee arthroplasty.Patella resurfacing has no effect on the shortening of patellar tendon.The shortening of patellar tendon may be one of the reasons causing the loss of the range of motion of the knee postoperatively.