全膝关节置换术中放开止血带并缝合内上缘支持带对髌骨轨迹的影响

目的 探讨在初次全膝关节置换术(TKA)中放开止血带且缝合内上缘支持带对髌骨轨迹的影响.方法 选择2006年3月至2008年2月初次行TKA的83例患者136侧膝关节.使用前内侧髌旁人路,检测髌骨轨迹.对于不良的髌骨轨迹,术中松开止血带且仅用一针缝合髌骨内上缘支持带.再次检查髌骨轨迹.最后,对残留不良髌骨轨迹的患者行外侧支持带松解术,以求获得满意的髌骨轨迹.采用no-thumb试验作为检测髌骨轨迹的标准.结果 在初次行TKA的83例患者136侧膝关节中,在未松开止血带前,髌骨轨迹不良率为64.7%(88/136).放开止血带且缝合髌骨内上缘支持带后,髌骨外侧支持带松解率为26.5%(36/136),差异有统计学意义(X2=38.55,P＜0.01).其中,膝外翻畸形患者的松解率为58.6%(17/29),膝内翻和无明显畸形患者的松解率为17.8%(19/107).结论 高压止血带对行前内侧髌旁人路TKA的患者髌骨轨迹的干扰作用非常明显.术中松开止血带且缝合髌骨内上缘支持带明显降低了外侧支持带的松解率,从而降低了其可能带来的并发症.

Influence of tourniquet application on patellar tracking during total knee arthroplasty

Objective To explore the influence of deflating the tourniquet and stitching the retinaculum at the superior-medial border on patellar tracking during total knee atthroplasty (TKA).Methods From March 2006 to February 2008,136 knees of 83 patients underwent primary TKA.The anterior-medial para-patellar approach was applied and the no-thumb's test was used to cheek the patellar tracking.In cases of maltracking,we deflated the tourniquets and used a single stitch to close the retinaculum at the superior medial border before the patellar tracking was checked again.Finally,if necessary,lateral retinaculum release (LRR) was performed to obtain the optimizing patellar tracking.Results In the 136 cases of primary TKA,the rote of patellar mahracking was 64.7% (88/136) before tourniquets were inflated,but 26.5% (36/136) after deflating tourniquets and stitching the retinaculum.The rate of LRR for valgus deformity was 58.6% (17/29) and that for varus deformity and no deformity was 17.8% (19/107).Conclusions There may be a significant influence of tourniquet application on patellar tracking during TKA.The method of deflating the tourniquet and using a single stitch to close the retinaculum at the superior medial border intraoperatively can correct patellar mahraeking and decrease the rate of LRR significantly.