全膝关节置换术后髌骨位置及活动度对全膝关节功能的影响

目的探讨全膝关节置换（TKA）术后患者髌骨位置、活动度的变化以及其对膝关节功能和活动的影响.方法 自1998年9月至2006年6月在上海交大医学院附属第九人民医院收治的205例初次TKA患者中选取资料完整、获得良好随访的51例患者（62个膝关节）,平均随访时间38.7个月,对其进行髌骨高度、倾斜角及侧方移动度进行测量,与术前对照,并与膝关节活动度做相关性统计分析,综合研究髌骨方面对膝关节功能影响的关键因素.结果 （1）TKA术后髌骨高度较术前下降,差别有统计学意义（P〈0.01）,髌骨外翻倾斜角减小;（2）髌腱短缩〉 10%时,其短缩程度与膝关节活动度呈负相关（r=-0.79,P〈0.01）;（3）髌骨活动度与膝关节活动度呈正相关（r=0.53,P〈0.01）.结论 （1）TKA术后髌韧带存在一定程度的短缩,髌骨不存在明显外翻;（2）髌骨位置及髌骨活动度影响膝关节功能：当髌腱短缩〉10%时,髌骨位置越低,膝关节活动度越小,膝关节功能越差;髌骨活动度越差,膝关节活动度越小.

The effects of Patellofemoral joint position and activity on the knee function after TKA

Objective To investigate the patellar position and activity after TKA and to explore their influences over the function and motion range of the knee joint. Methods 51 patients （62 knees） of TKA in Shanghai No. 9 People＇s hospital from 1998.9-2006. 6 were followed up, and the average follow-up time was 38.7 months. Radiography was used to evaluate patella position and movement tracking. A special patellar clamp apparatus was designed to measure the medial-lateral patellofemoral activity. The correlation between each patellar parameter including prosthesis type and the range of knee motion after TKA was evaluated statistically. Results （ 1 ） The preoperative and postoperative patellar height and the lateral angle both showed statistic significant differenee, whieh significantly decreased postoperatively （ P 〈 0.01 ） ; （2） When the shortening of patellar tendon was over 10% , there was negative correlation between the height of patella and ROM （r = -0. 79, P 〈0. 01 ） ; （3） There was positive correlation between the medial-lateral movement of patella and the ROM of knee with correlation coefficient of 0. 53 （ r = 0. 53, P 〈 0. 01 ）. Conclusions （ 1 ） The shortening of patello-tendon was obvious alter TKA ; （2） The height of patella influenced the function of knee when the shortening of patellotendon was more than 10% ; （3） The medial-lateral movement of patella influenced the function of knee.