Hempfing Axel, Schoeniger Ralf, Koch Peter P, Bischel Oliver, Thomsen Marc
University of Heidelberg, Orthopaedic Department, Schlierbacher Landstr. 200a, 69118 Schlierbach-Ziegelhausen, Germany.
J Orthop Res. 2007 Oct;25(10):1389-94. doi: 10.1002/jor.20416.
Patellofemoral complications following knee arthroplasty are a well-known problem. Patellar ischemia has been suspected to be causative for fracture, anterior knee pain, and patella component failure. The purpose of this study was to assess the influence of knee arthroplasty surgical dissection on patellar blood flow. Patellar blood flow was measured by means of intraosseous laser Doppler flowmetry (LDF) in 10 patients undergoing total knee arthroplasty by a standard medial parapatellar approach. The initial blood flow was 121.6 +/- 114.7 AU. The signal significantly decreased by 71% (p = 0.0051) when the knee was flexed and lost the pulsatile signal pattern in 80%. After arthrotomy, the signal was 100.1 +/- 120.3 AU in extension. The lowest signal was found in flexion and eversion of the patella (mean, 18 +/- 10.7 AU) and all signals lost pulsatility. As compared to the initial values, completion of the soft tissue dissection did not lead to a significant change of the blood flow signal (121.3 +/- 104.8; p = 0.6835). Flexion of the knee joint markedly reduced patellar perfusion. Standard medial parapatellar approach did not significantly change patellar blood flow. This study does not support the theory of postoperative patellar ischemia as a cause of anterior knee pain or patellofemoral problems.
膝关节置换术后髌股关节并发症是一个众所周知的问题。髌股缺血被怀疑是导致骨折、膝关节前方疼痛和髌骨部件失效的原因。本研究的目的是评估膝关节置换手术解剖对髌骨血流的影响。采用骨内激光多普勒血流仪（LDF）对10例行标准内侧髌旁入路全膝关节置换术的患者的髌骨血流进行测量。初始血流为121.6±114.7 AU。当膝关节屈曲时，信号显著下降71%（p = 0.0051），80%的信号失去搏动信号模式。切开关节囊后，伸直位信号为100.1±120.3 AU。在髌骨屈曲和外翻时发现最低信号（平均18±10.7 AU），所有信号均失去搏动性。与初始值相比，软组织解剖完成后血流信号无显著变化（121.3±104.8；p = 0.6835）。膝关节屈曲显著降低髌骨灌注。标准内侧髌旁入路未显著改变髌骨血流。本研究不支持术后髌股缺血是膝关节前方疼痛或髌股关节问题原因的理论。
