髌下脂肪垫切除对全膝关节置换预后的影响

目的：探讨髌下脂肪垫（infrapatellar fat pad, IPFP）的保留或切除对全膝关节置换术预后的影响。方法对2014年1月至2015年4月于我院就诊的110例（118膝）膝骨关节炎患者进行随机对照研究，采用随机数字表法将其随机分入IPFP切除组和IPFP保留组，各59膝。记录并比较两组患者术前及术后1个月、1年时的改良Insall?Salvati指数和美国膝关节协会（American Knee Society, AKS）评分系统膝评分。结果两组患者组内术后1个月、术后1年的改良Insall?Salvati指数分别与术前比较，差异均无统计学意义（均P＞0.05），但AKS膝评分均较术前改善，差异均有统计学意义（均P＜0.05）；两组患者术前、术后1个月、术后1年的改良Insall?Salvati指数及AKS膝评分组间相比较，差异均无统计学意义（均P＞0.05）。IPFP切除组有2例切口远端渗出，愈合不良，经定期换药，术后3周愈合，1例术后1年有膝前痛；IPFP保留组切口均愈合良好，4例术后1年随访时有膝前痛。结论切除IPFP对全膝关节置换术后膝关节功能无明显影响，可予以切除以增加术野暴露或部分切除以保护“密集血管区”。

Influence of infrapatellar fat pad resection during total knee arthroplasty

Objective To investigate the influence of the infrapatellar fat pad (IPFP) resection during total knee arthroplasty (TKA). Methods Cases of 110 patients (118 knees) of osteoarthritis in our hospital from January 2014 to April 2015 were randomly divided into two groups. The IPFP was resected in the IPFP resected group (59 knees), and preserved in IPFP preserved group (59 knees). The Modified Insall?Salvati ratio and the American Knee Society (AKS) scoring system were followed up preoperation, and 1 month and 1 year after operation. Results The Modified Insall?Salvati ratio in IPFP resected group showed no significant dif?ference preoperation and 1 month and 1 year after operation, but the AKS knee scores showed statistical signifi?cant difference. The same results were observed in IPFP reserved group. The Modified Insall?Salvati ratio and AKS knee scores preoperation, and 1 month and 1 year after operation had no statistically significant difference between the two groups. Incision complication occurred in 2 cases of IPFP resected group, healed by changing dressings after 3 weeks, and anterior knee pain in one case, while all incisions in IPFP preserved group healed well, and 4 cases got anterior knee pain during a follow?up period of 1 year. Conclusion Resecting the IPFP or not has no obvious effect on the function of knee joint after TKA. We could carefully consider resecting the IPFP completely or partially during TKA so as to protect the“vascular dense area”.