单髁膝关节置换术后髌腱长度的变化
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摘要
目的研究单髁膝关节置换(Unicompartmental knee arthroplasty, UKA)术后的髌腱是否存在短缩,与全膝关节表面置换术(Total knee arthropalsty, TKA)进行比较,体现其优越性。
方法回访2005年1月-2008年1月由同一位骨科医师在山西医科大学第二附属医院骨科及太原华晋医院骨科对膝关节骨关节炎行单髁膝关节置换手术的患者,共50例患者61膝,其中13例失访或死亡。37例得到回访,均未翻修或出现功能明显不良。由于3例骨性标志不明显而被排外,故留下34例41膝。术后时间最长为44个月,最短为8个月,平均24.3月。应用计算机X线摄影系统拍摄术前术后标准侧位X线片,在X线片上利用AUTOCAD软件测量术前及术后8个月以后的髌腱长度,髌腱长度测量方法是测量从髌骨下极上方的髌腱附着点深层到胫骨结节近侧边缘切迹的距离；应用量角器测量单髁膝关节置换术前术后膝关节屈曲度；对每例患者术前术后进行WOMAC (Western Ontarion and Macmaster)评分,对数据进行配对t检验的统计学分析。参考既往文献对全膝关节表面置换屈曲度的相关报道,把该值做为参考值,对单髁膝关节置换术后膝关节屈曲度进行单样本t检验的统计学分析。
结果全部患者术后8个月到44个月随访时无感染,松动等并发症,术前WOMAC均分32.6分,术后WOMAC均分5.2分。术前术后WOMAC积分差异有统计学意义,p<0.01,WOMAC积分由术前的一般等级转变为术后的优良等级,说明单髁膝关节置换术后疼痛明显改善,功能明显恢复,疗效好。术前髌腱长度平均41.32毫米,术后41.08毫米,术后髌腱短缩范围-13%-10%(-4.71毫米-3.71毫米),平均0.46%(0.2434毫米),单髁膝关节置换术前术后髌腱长度差异无统计学意义,p>0.01。单髁膝关节置换术后没有发生髌腱短缩而既往文献报道全膝关节表面置换术后发生髌腱短缩且短缩与膝关节屈曲度负相关。单髁膝关节置换术后屈膝最大140°,最少85°,平均120.5°,而术前屈膝最大140°,最少20°,平均106.7°。术前术后屈曲度差异有统计学意义,术后屈曲度增加,p<0.01。与全膝关节表面置换比较(既往大量研究证明全膝置换术后中期膝关节屈曲度平均为107°)单髁膝关节置换术后屈曲度更大,p<0.01。
结论单髁膝关节置换术后8个月-44个月疗效优良,没发生髌腱短缩。单髁膝关节置换术对伸膝装置及膝关节生物力学机制干扰轻,相对于全膝置换而言它能更大限度地恢复正常的膝关节运动学特性,从这方面讲值得推广
Objective:To investigate the change in the length of patellar tendon after Unicompartmental knee arthroplasty, compare with Total knee arthroplastyand to embody its superiority.
Methods:The unicompartmental knee arthroplasty were performed on sixty-one knees of fifty patients from January 2005 to January 2008 by one surgeon at Department of Orthopaedics,Taiyuan Huajin Hospital and Department of Orthopaedics, the Second Hospital of Shanxi Medical University.The osteoarthritis was diagnosed in all knees. Thirteen patients were unavailable for review because of death or lossto follow-up.Clinical details were available for the remaining forty-one knees since bone-sign of three knees were not obviously. Time of follow-up is from eight months to forty-four months after operation. Standard lateral radiographs of the knees were taken by computer radiographs system, the length of patellar tendon was measured before and eight months after operation by AUTOCAD software, method of measurement is to measure the distance from a point on the inferior pole of the patella and the tibial tuberosity. The range of flexion was measured by a goniometer. WOMAC (Western Ontarion and MacMamster) Score were recorded before and eight months after the operation. The statistical analysis was made by paired t-test. One sample t-test of the range of flexion was made by reference documents of TKA.
Results:forty-one patients were followed up for 8-44months. No complication, infection, loosening occurred. The WOMAC score before operation is 32.6,after operation is 5.2. there was statistical significant between before and after the operation (P<0.01). It means therapeutic effect after operation is very great. The mean length of patellar tendon before operation is 41.3mm,after operation is 41.08mm. after operation,the patellar tendon had shortened by a mean of 0.46%(-13%-10%shorter). there was no statistical significant between the length of patellar tendon before and after operation(P＞0.01), the length after TKA had no significant change,but TKA had. there was statistical significant between range of flexion before and after the operation (P<0.01).The range of flexion after UKA operation is greater than UKA, P<0.01.
Conclusion:Eight to forty-four months therapeutic effect after UKA is excellent, the length of patellar tendon after UKA had no significant change, it has injury and interference with biomechanics of knee and extensor apparatus more lightly. Compared with Total knee arthroplastyand,it can recover the motion characteristics of knee more excellent. As far as it is concerned,It is worth of spreading.
方法回访2005年1月-2008年1月由同一位骨科医师在山西医科大学第二附属医院骨科及太原华晋医院骨科对膝关节骨关节炎行单髁膝关节置换手术的患者,共50例患者61膝,其中13例失访或死亡。37例得到回访,均未翻修或出现功能明显不良。由于3例骨性标志不明显而被排外,故留下34例41膝。术后时间最长为44个月,最短为8个月,平均24.3月。应用计算机X线摄影系统拍摄术前术后标准侧位X线片,在X线片上利用AUTOCAD软件测量术前及术后8个月以后的髌腱长度,髌腱长度测量方法是测量从髌骨下极上方的髌腱附着点深层到胫骨结节近侧边缘切迹的距离；应用量角器测量单髁膝关节置换术前术后膝关节屈曲度；对每例患者术前术后进行WOMAC (Western Ontarion and Macmaster)评分,对数据进行配对t检验的统计学分析。参考既往文献对全膝关节表面置换屈曲度的相关报道,把该值做为参考值,对单髁膝关节置换术后膝关节屈曲度进行单样本t检验的统计学分析。
结果全部患者术后8个月到44个月随访时无感染,松动等并发症,术前WOMAC均分32.6分,术后WOMAC均分5.2分。术前术后WOMAC积分差异有统计学意义,p<0.01,WOMAC积分由术前的一般等级转变为术后的优良等级,说明单髁膝关节置换术后疼痛明显改善,功能明显恢复,疗效好。术前髌腱长度平均41.32毫米,术后41.08毫米,术后髌腱短缩范围-13%-10%(-4.71毫米-3.71毫米),平均0.46%(0.2434毫米),单髁膝关节置换术前术后髌腱长度差异无统计学意义,p>0.01。单髁膝关节置换术后没有发生髌腱短缩而既往文献报道全膝关节表面置换术后发生髌腱短缩且短缩与膝关节屈曲度负相关。单髁膝关节置换术后屈膝最大140°,最少85°,平均120.5°,而术前屈膝最大140°,最少20°,平均106.7°。术前术后屈曲度差异有统计学意义,术后屈曲度增加,p<0.01。与全膝关节表面置换比较(既往大量研究证明全膝置换术后中期膝关节屈曲度平均为107°)单髁膝关节置换术后屈曲度更大,p<0.01。
结论单髁膝关节置换术后8个月-44个月疗效优良,没发生髌腱短缩。单髁膝关节置换术对伸膝装置及膝关节生物力学机制干扰轻,相对于全膝置换而言它能更大限度地恢复正常的膝关节运动学特性,从这方面讲值得推广
Objective:To investigate the change in the length of patellar tendon after Unicompartmental knee arthroplasty, compare with Total knee arthroplastyand to embody its superiority.
Methods:The unicompartmental knee arthroplasty were performed on sixty-one knees of fifty patients from January 2005 to January 2008 by one surgeon at Department of Orthopaedics,Taiyuan Huajin Hospital and Department of Orthopaedics, the Second Hospital of Shanxi Medical University.The osteoarthritis was diagnosed in all knees. Thirteen patients were unavailable for review because of death or lossto follow-up.Clinical details were available for the remaining forty-one knees since bone-sign of three knees were not obviously. Time of follow-up is from eight months to forty-four months after operation. Standard lateral radiographs of the knees were taken by computer radiographs system, the length of patellar tendon was measured before and eight months after operation by AUTOCAD software, method of measurement is to measure the distance from a point on the inferior pole of the patella and the tibial tuberosity. The range of flexion was measured by a goniometer. WOMAC (Western Ontarion and MacMamster) Score were recorded before and eight months after the operation. The statistical analysis was made by paired t-test. One sample t-test of the range of flexion was made by reference documents of TKA.
Results:forty-one patients were followed up for 8-44months. No complication, infection, loosening occurred. The WOMAC score before operation is 32.6,after operation is 5.2. there was statistical significant between before and after the operation (P<0.01). It means therapeutic effect after operation is very great. The mean length of patellar tendon before operation is 41.3mm,after operation is 41.08mm. after operation,the patellar tendon had shortened by a mean of 0.46%(-13%-10%shorter). there was no statistical significant between the length of patellar tendon before and after operation(P＞0.01), the length after TKA had no significant change,but TKA had. there was statistical significant between range of flexion before and after the operation (P<0.01).The range of flexion after UKA operation is greater than UKA, P<0.01.
Conclusion:Eight to forty-four months therapeutic effect after UKA is excellent, the length of patellar tendon after UKA had no significant change, it has injury and interference with biomechanics of knee and extensor apparatus more lightly. Compared with Total knee arthroplastyand,it can recover the motion characteristics of knee more excellent. As far as it is concerned,It is worth of spreading.
引文
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[1]Gejo R, Morita Y, Matsushita I,et al. Joint gap changes with patellar tendon strain and patellar position during TKA. Clin Orthop Relat Res.2008,466:946-951.
[2]Reider B Marshall JL,Koslin B,et al.The anterior aspect of the knee joint anatomic study.J Bone joint surg (am),1981,63:351-356
[3]Noyes FR, wojtys EM, Masrhall MT. The early diagnosis and treatment of developmental Patella inefra syndrome.Clin OrthoP,1991,265:241-252.
[4]唐光健.骨关节放射学.北京：人民卫生出版社,2004：127
[5]Insall NJ,Salvati E. Patella Position in the normal knee joint.Radiology,1971,101:101 -104.
[6]Kettelkamp DB, Johnson RG, Smidt GL, et al.An eletrogoniometric study of knee motion in normal gait. J Bone Joint Surg (Am),1970,52:775-779.
[7]Insall NJ,Scott W, RnaawatCS.The totale on dylarknee Prosthesis. Twohundred and twenty cases. JBoneJointSugrAm1979,61:173 - 180.
[8]TewM, ForsterIW, Walla.Eeffect of total knee arthroPlasty on maximalflexion.ClinOrthoP, 1989,247:168 - 74.
[9]EwaldFC, WrlghtRJ, PossR, etal. Kinematie total knee arthroPlasyt:a10to14year ProsPective follow Pur evie.wJ ArthroPlasty 1999,14:473 - 480.
[10]CallaghnaJJ, SquierM W, GoetzDD, etal.Cemented rotating Plateform total knee rePlacement.A nine to twelve year follow. Pustudy.JBoneJointSugr(Am),2000,82:705- 711.
[11]DemrisDA, KomistekRD, StiehlJB, etal. Range of motion after total knee arthroPlasty:the effect of implant design weight - bearing conditions.J ArthroPlasyt,1998,13:748 - 752.
[12]Ritter MA,Berend ME,Harty LD, et al. Predicting range of motion after revision total knee arthroplasty:clustering and log-linear regression analyses. Arthroplasty.2004,19:338-343
[13]Van Eijden TM, Kouwenhoven E. Mechanics of the patellar articulation:effects of patellar ligament length studied with a mathematical model. Acta Orthop Scand,1987,58:560-566
[14]Dennis DA, Komistek RD, Scuderi GR.Factors affecting flexion after total knee arthroplasty. Clin Orthop Relat Res.2007,464:353-359
[15]InsallNJ, SeottWN, RnaawatCS.The total condylarknee Prosthesis.Two hundred and twenty cases.J BoneJointSugrAm1979,61:173 - 180.
[16]Meyer SA, Brown TD, Pedersen DR, Albright JP. Retropatellar contact stress in simulated patella infera. Am J Knee Surg 1997,10:129-138
[17]Aho K, Sainio K, Kianta M, Varpanen E. Pneumatic tourniquet paralysis:case report. J Bone Joint Surg (Br) 1983;65-B:441-443.
[18]Dobner JJ, Nitz AJ. Postmeniscectomy tourniquet palsy and functional sequelae. Am J Sports Med 1982,26:211-214.
[19]Mariani PP, Del Signore S, Perugia L. Early development of patella infera after knee fractures. Knee Surg Sports Traumatol Arthrosc,l994,39:166-169.
[20]Dandy DJ, Desai SS. Patellar tendon length after anterior cruciate ligament reconstruction. J Bone Joint Surg (Br),1994,76-B:198-199
[21]Okamoto R, Koshino T, Morii T. Shortening of patellar ligament and patella baja with improvement of quadriceps muscle strength after high tibial osteotomy. Bull Hosp Jt Dis,1993,53:21-24.
[22]Scuderi GR, Windsor RE, Insall JN. Observations on patellar height after proximal tibial osteotomy. J Bone Joint Surg (Am),1989;71-A(3):245-248.
[23]Weale AE, Murrya DW, Newman JH, et al. The length of the Patellar tendon after unicompartmental and total knee replacement.J Bone Joint Sugreyr(Br),1999,81:790-796
[24]Aglietti P, Buzzi R, Gaudenzi A. Patello-femoral functional results and complications with the posterior stabilised total condylar knee prosthesis. J Arthroplasty 1988;3:17-25.
[25]Fern ED, Winson IG, Getty CJM. Anterior knee pain in rheumatoid patients after total knee replacement:possible selection criteria for patellar resurfacing. J Bone Joint Surg [Br] 1992;74-B:745-8.
[26]Figgie HE In, Goldbegr VM, HeiPle KG, et al.The influence of tibial Patelloefmoral location on function of the knee in Patients with the posterior stabilized condylar knee proshetsis.J Bone Joint Sugr(Am),1986,68-A:1035-1040.
[27]Koshino T, Ejima M, Okamoto R, Morii T. Gradual low riding of the patella during postoperative course after total knee arthroplasty in osteoarthritis and rheumatoid arthritis. J Arthroplasty 1990;5:323-7.
[28]周晓波,吴海山,徐长明等.全膝置换术后的髌腱短缩及其临床影响.中国骨与关节损伤杂志,2006,21(3)：182-184
[29]Wojtys EM, Oakes B, Lindenfeld TN. Patella infera syndrome:an analysis of the patellar tendon pathology. Instr Course Lect,1997,46:241-50
[30]Dandy DJ, Desai SS. Patellar tendon length after anterior cruciate ligament reconstruction. J Bone Joint Surg (Br),1994,76:198-201
[31]Noyes FR, Wojtys EM. The early recognition, diagnosis and treatment of the patella infera syndrome. Instr Course Lect,1991,40:233-247
[32]Windsor RE, Insall JN, Vince KG. Technical considerations of total knee arthroplasty after proximal tibial osteotomy. J Bone Joint Surg(Am),1988;70-A:547-55.
[33]Scuderi GR, Windsor RE, Insall JN. Observations on patellar height after proximal tibial osteotomy. J Bone Joint Surg (Am),1989,71-A:245-8
[34]倪国新.关节制动对韧带的影响.国外医学·物理医学与康复学分册,1997,]7(7)：658-60
[35]Borus T, Thornhill T. Unicompartmental knee arthroplasty. J Am Acad Orthop Surg. 2008,16(1):9-18
[36]John H.Newman,Christopher E.Unicompartmental or total knee replacement? J Bone Joint Sugreyr(Br),1998,78:776-779
[37]于海驰,张远鹰.全膝关节置换术围手术期相关问题的处理.吉林医学,2007,28,(5)445-448
[38]Gunston FH. Polycantric knee arthroplasty.Prosthetic simulation of normal knee movement. J Bone Joint Surg(Br),1971,53:272-277.
[39]Marmot L. The modular knee. Clin Orthop Relat Res,1973,90 (3):242-248.
[40]Swienckowski JJ,Pennington DW.Unicompartmental knee arthroplasty in patients sixty years of age or younger.J Bone Joint Surg Am,2004,86:131-142.
[41]Berger RA,Meneghini RM,Jacobs JJ,et al.Results of unicompartmental knee arthroplasty at a minimum of ten years of follow up. J Bone Joint Surg Am,2005,87:999-1006.
[42]Isaac SM, BarkerKL,Danial IN,etal.Does arthroplasty type influence knee joint proprioception? A longitudinal prospective study comparing total and unicompartmental arthroplasty. The knee,2007,14:212-217
[43]Steele RG,Hutabarat S, Evans RL,et al.Survivorship of the stgeorgsled medial unicompartmental knee replacement beyond ten years. J Bone JointSurg(Br),2006,88-B: 1164-1168.
[44]O'Connor JJ, Goodfellow JW, Dodd CA. Development and clinical application of meniscal unicompartmental arthroplasty. J Proc Inst Mech Eng [H],2007,42:47-59.
[45]Hube R, Keim M J. Minimally invasive implantation in unicondylar arthroplasty. Orthopade.2007,36:1093-9
[46]Jenny JY.Navigated unicompartmental knee replacement.Orthopedics,2005;28:1263-1267
[47]Hernigou P,Deschamps GNavigation for Unicompartmental Arthroplasty.Techniques in Knee Surgery,2006,25:218-227
[48]张卫国,夏仁云.人工内侧单髁置换对膝关节伸屈过程中胫骨轴向旋转的影响.中国骨 与关节损伤杂志,2008,23(3)：208-209
[49]王晓峰.全膝关节置换术后膝关节的运动学分析.中国骨与关节损伤杂志，2005,20(5)：342-345
[50]Cobb AG, Kozinn SC, Scott RD:Unicompartmental or total knee replacement.:the patients preference. J Bone Joint Surg Br,1990,72(2):166-167
[51]Newman JH, Ackroyd CE, Shah NA. Unicompartmental or total knee replacement? five-years results of a prospective randomized trial of 102osteoarthritic knee with Unicompartmental arthroplasty.J Bone Joint Surg (Br),1989,80(9):862,
[52]Lizuar A, MareoL, Cebrina R. PeroPerative influence the range of movement after total knee arthorPlasty. J BoneJoint Surg(Br),1997,79:626 - 629.
[53]Btter MA, HartyLD, DvaisKE, etal. PrediCting rnage of motion after total knee arthroPlasty. J Bone
Joint Sugr(Am),2003,85:1278 - 1285.
[2]张卫国,夏仁云.人工内侧单髁置换对膝关节伸屈过程中胫骨轴向旋转的影响.中国骨与关节损伤杂志,2008,23(3)：208-209
[3]王晓峰.全膝关节置换术后膝关节的运动学分析.中国骨与关节损伤杂志，2005,20(5)：342-345
[4]Kettelkamp DB, Johnson RG, Smidt GL, et al.An eletrogoniometric study of knee motion in normal gait. J Bone Joint Surg (Am),1970,52:775-779.
[5]Ritter MA,Berend ME,Harty LD, et al. Predicting range of motion after revision total knee arthroplasty:clustering and log-linear regression analyses. Arthroplasty.2004,19:338-343
[6]Gejo R, Morita Y, Matsushita I,et al. Joint gap changes with patellar tendon strain and patellar position during TKA. Clin Orthop Relat Res.2008,466:946-951.
[7]Reider B Marshall JL,Koslin B,et al.The anterior aspect of the knee joint anatomic study.J Bone joint surg (am),1981,63:351-356
[8]Noyes FR, wojtys EM, Masrhall MT. The early diagnosis and treatment of developmental Patella inefra syndrome.Clin OrthoP,1991,265:241-252.
[9]Aho K, Sainio K, Kianta M, Varpanen E. Pneumatic tourniquet paralysis:case report. J Bone Joint Surg (Br) 1983;65-B:441-443.
[10]Dobner JJ, Nitz AJ. Postmeniscectomy tourniquet palsy and functional sequelae. Am J Sports Med 1982,26:211-214.
[11]Mariani PP, Del Signore S, Perugia L. Early development of patella infera after knee fractures. Knee Surg Sports Traumatol Arthrosc,1994,39:166-169.
[12]Dandy DJ, Desai SS. Patellar tendon length after anterior cruciate ligament reconstruction. J Bone Joint Surg (Br),1994,76-B:198-199
[13]Okamoto R, Koshino T, Morii T. Shortening of patellar ligament and patella baja with improvement of quadriceps muscle strength after high tibial osteotomy. Bull Hosp Jt Dis,1993,53:21-24.
[14]Scuderi GR, Windsor RE, Insall JN. Observations on patellar height after proximal tibial osteotomy. J Bone Joint Surg (Am),1989;71-A(3):245-248.
[15]Weale AE, Murrya D W, Newman J H, et al.The length of the Patellar tendon after unicompartmental and total knee replacement.J Bone Joint Sugreyr(Br),1999,81:790-796
[16]周晓波,吴海山,徐长明等.全膝置换术后的髌腱短缩及其临床影响.中国骨与关节损伤 杂志,2006,21(3)：182-184
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[22]Dennis DA,Komistek RD,Stiehl JB,et al.Range of motion after total knee arthroplasty:the effect of implant design and weight-bearing conditions.J Arthroplasty,1998,13:748-752.
[23]Figgie HE In, Goldbegr VM, HeiPle KG, et al.The influence of tibial Patelloefmoral location on function of the knee in Patients with the posterior stabilized condylar knee proshetsis.J Bone Joint Sugr(Am),1986,68-A:1035-1040.
[24]Koshino T, Ejima M, Okmaoto R, et al.Gradual low riding of the Patella during Postoperative course after total knee arthroplasty in osteoarthritis. J ArthroPlasty,1990, 5:323-327.
[25]Wojtys EM, Oakes B, Lindenfeld TN. Patella infera syndrome:an analysis of the patellar tendon pathology. Instr Course Lect,1997,46:241-50
[26]Dandy DJ, Desai SS. Patellar tendon length after anterior cruciate ligament reconstruction. J Bone Joint Surg (Br),1994,76:198-201
[27]Noyes FR, Wojtys EM. The early recognition, diagnosis and treatment of the patella infera syndrome. Instr Course Lect,1991,40:233-247
[28]Windsor RE, Insall JN, Vince KG. Technical considerations of total knee arthroplasty after proximal tibial osteotomy. J Bone Joint Surg(Am),1988;70-A:547-55.
[29]Scuderi GR, Windsor RE, Insall JN. Observations on patellar height after proximal tibial osteotomy. J Bone Joint Surg (Am),1989,71-A:245-8
[30]倪国新.关节制动对韧带的影响.国外医学·物理医学与康复学分册,1997,17(7)：658-60
[31]Borus T, Thornhill T. Unicompartmental knee arthroplasty. J Am Acad Orthop Surg. 2008,16(1):9-18
[32]John H.Newman,Christopher E.Unicompartmental or total knee replacement? J Bone Joint Sugreyr(Br),1998,78:776-779
[33]于海驰,张远鹰.全膝关节置换术围手术期相关问题的处理.吉林医学,2007,28,(5) 445-448
[34]Meyer SA, Brown TD, Pedersen DR, Albright JP. Retropatellar contact stress in simulated patella infera. Am J Knee Surg 1997,10:129-138
[35]Van Eijden TM, Kouwenhoven E. Mechanics of the patellar articulation:effects of patellar ligament length studied with a mathematical model. Acta Orthop Scand,1987,58:560-566
[36]Dennis DA, Komistek RD, Scuderi GR.Factors affecting flexion after total knee arthroplasty. Clin Orthop Relat Res.2007,464:353-359
[37]Gunston FH. Polycantric knee arthroplasty.Prosthetic simulation of normal knee movement. J Bone Joint Surg(Br),1971,53:272-277.
[38]Marmot L. The modular knee. Clin Orthop Relat Res,1973,90 (3):242-248.
[39]Swienckowski JJ,Pennington DW.Unicompartmental knee arthroplasty in patients sixty years of age or younger.J Bone Joint Surg Am,2004,86:131-142.
[40]Berger RA,Meneghini RM,Jacobs JJ,et al.Results of unicompartmental knee arthroplasty at a minimum of ten years of follow up. J Bone Joint Surg Am,2005,87:999-1006.
[41]Isaac SM, BarkerKL,Danial IN,etal.Does arthroplasty type influence knee joint proprioception? A longitudinal prospective study comparing total and unicompartmental arthroplasty. The knee,2007,14:212-217
[42]Steele RG,Hutabarat S, Evans RL,et al.Survivorship of the stgeorgsled medial unicompartmental knee replacement beyond ten years. J Bone JointSurg(Br),2006,88-B: 1164-1168.
[43]O'Connor JJ, Goodfellow JW, Dodd CA. Development and clinical application of meniscal unicompartmental arthroplasty. J Proc Inst Mech Eng [H],2007,42:47-59.
[44]Hube R, Keim M J. Minimally invasive implantation in unicondylar arthroplasty. Orthopade.2007,36:1093-9
[45]Jenny JY.Navigated unicompartmental knee replacement.Orthopedics,2005;28:1263-1267
[46]Hernigou P,Deschamps G.Navigation for Unicompartmental Arthroplasty.Techniques in Knee Surgery,2006,25:218-227
[47]Cobb AG, Kozinn SC, Scott RD:Unicompartmental or total knee replacement.:the patients preference. J Bone Joint Surg Br,1990,72(2):166-167
[48]Newman JH, Ackroyd CE, Shah NA. Unicompartmental or total knee replacement? five-years results of a prospective randomized trial of 102osteoarthritic knee with Unicompartmental arthroplasty.J Bone Joint Surg (Br),1989,80(9):862
[49]娄思权,张克。单髁(室)人工膝关节表面置换术。中国人工关节杂志,2006,10(2)：96.
[1]Gejo R, Morita Y, Matsushita I,et al. Joint gap changes with patellar tendon strain and patellar position during TKA. Clin Orthop Relat Res.2008,466:946-951.
[2]Reider B Marshall JL,Koslin B,et al.The anterior aspect of the knee joint anatomic study.J Bone joint surg (am),1981,63:351-356
[3]Noyes FR, wojtys EM, Masrhall MT. The early diagnosis and treatment of developmental Patella inefra syndrome.Clin OrthoP,1991,265:241-252.
[4]唐光健.骨关节放射学.北京：人民卫生出版社,2004：127
[5]Insall NJ,Salvati E. Patella Position in the normal knee joint.Radiology,1971,101:101 -104.
[6]Kettelkamp DB, Johnson RG, Smidt GL, et al.An eletrogoniometric study of knee motion in normal gait. J Bone Joint Surg (Am),1970,52:775-779.
[7]Insall NJ,Scott W, RnaawatCS.The totale on dylarknee Prosthesis. Twohundred and twenty cases. JBoneJointSugrAm1979,61:173 - 180.
[8]TewM, ForsterIW, Walla.Eeffect of total knee arthroPlasty on maximalflexion.ClinOrthoP, 1989,247:168 - 74.
[9]EwaldFC, WrlghtRJ, PossR, etal. Kinematie total knee arthroPlasyt:a10to14year ProsPective follow Pur evie.wJ ArthroPlasty 1999,14:473 - 480.
[10]CallaghnaJJ, SquierM W, GoetzDD, etal.Cemented rotating Plateform total knee rePlacement.A nine to twelve year follow. Pustudy.JBoneJointSugr(Am),2000,82:705- 711.
[11]DemrisDA, KomistekRD, StiehlJB, etal. Range of motion after total knee arthroPlasty:the effect of implant design weight - bearing conditions.J ArthroPlasyt,1998,13:748 - 752.
[12]Ritter MA,Berend ME,Harty LD, et al. Predicting range of motion after revision total knee arthroplasty:clustering and log-linear regression analyses. Arthroplasty.2004,19:338-343
[13]Van Eijden TM, Kouwenhoven E. Mechanics of the patellar articulation:effects of patellar ligament length studied with a mathematical model. Acta Orthop Scand,1987,58:560-566
[14]Dennis DA, Komistek RD, Scuderi GR.Factors affecting flexion after total knee arthroplasty. Clin Orthop Relat Res.2007,464:353-359
[15]InsallNJ, SeottWN, RnaawatCS.The total condylarknee Prosthesis.Two hundred and twenty cases.J BoneJointSugrAm1979,61:173 - 180.
[16]Meyer SA, Brown TD, Pedersen DR, Albright JP. Retropatellar contact stress in simulated patella infera. Am J Knee Surg 1997,10:129-138
[17]Aho K, Sainio K, Kianta M, Varpanen E. Pneumatic tourniquet paralysis:case report. J Bone Joint Surg (Br) 1983;65-B:441-443.
[18]Dobner JJ, Nitz AJ. Postmeniscectomy tourniquet palsy and functional sequelae. Am J Sports Med 1982,26:211-214.
[19]Mariani PP, Del Signore S, Perugia L. Early development of patella infera after knee fractures. Knee Surg Sports Traumatol Arthrosc,l994,39:166-169.
[20]Dandy DJ, Desai SS. Patellar tendon length after anterior cruciate ligament reconstruction. J Bone Joint Surg (Br),1994,76-B:198-199
[21]Okamoto R, Koshino T, Morii T. Shortening of patellar ligament and patella baja with improvement of quadriceps muscle strength after high tibial osteotomy. Bull Hosp Jt Dis,1993,53:21-24.
[22]Scuderi GR, Windsor RE, Insall JN. Observations on patellar height after proximal tibial osteotomy. J Bone Joint Surg (Am),1989;71-A(3):245-248.
[23]Weale AE, Murrya DW, Newman JH, et al. The length of the Patellar tendon after unicompartmental and total knee replacement.J Bone Joint Sugreyr(Br),1999,81:790-796
[24]Aglietti P, Buzzi R, Gaudenzi A. Patello-femoral functional results and complications with the posterior stabilised total condylar knee prosthesis. J Arthroplasty 1988;3:17-25.
[25]Fern ED, Winson IG, Getty CJM. Anterior knee pain in rheumatoid patients after total knee replacement:possible selection criteria for patellar resurfacing. J Bone Joint Surg [Br] 1992;74-B:745-8.
[26]Figgie HE In, Goldbegr VM, HeiPle KG, et al.The influence of tibial Patelloefmoral location on function of the knee in Patients with the posterior stabilized condylar knee proshetsis.J Bone Joint Sugr(Am),1986,68-A:1035-1040.
[27]Koshino T, Ejima M, Okamoto R, Morii T. Gradual low riding of the patella during postoperative course after total knee arthroplasty in osteoarthritis and rheumatoid arthritis. J Arthroplasty 1990;5:323-7.
[28]周晓波,吴海山,徐长明等.全膝置换术后的髌腱短缩及其临床影响.中国骨与关节损伤杂志,2006,21(3)：182-184
[29]Wojtys EM, Oakes B, Lindenfeld TN. Patella infera syndrome:an analysis of the patellar tendon pathology. Instr Course Lect,1997,46:241-50
[30]Dandy DJ, Desai SS. Patellar tendon length after anterior cruciate ligament reconstruction. J Bone Joint Surg (Br),1994,76:198-201
[31]Noyes FR, Wojtys EM. The early recognition, diagnosis and treatment of the patella infera syndrome. Instr Course Lect,1991,40:233-247
[32]Windsor RE, Insall JN, Vince KG. Technical considerations of total knee arthroplasty after proximal tibial osteotomy. J Bone Joint Surg(Am),1988;70-A:547-55.
[33]Scuderi GR, Windsor RE, Insall JN. Observations on patellar height after proximal tibial osteotomy. J Bone Joint Surg (Am),1989,71-A:245-8
[34]倪国新.关节制动对韧带的影响.国外医学·物理医学与康复学分册,1997,]7(7)：658-60
[35]Borus T, Thornhill T. Unicompartmental knee arthroplasty. J Am Acad Orthop Surg. 2008,16(1):9-18
[36]John H.Newman,Christopher E.Unicompartmental or total knee replacement? J Bone Joint Sugreyr(Br),1998,78:776-779
[37]于海驰,张远鹰.全膝关节置换术围手术期相关问题的处理.吉林医学,2007,28,(5)445-448
[38]Gunston FH. Polycantric knee arthroplasty.Prosthetic simulation of normal knee movement. J Bone Joint Surg(Br),1971,53:272-277.
[39]Marmot L. The modular knee. Clin Orthop Relat Res,1973,90 (3):242-248.
[40]Swienckowski JJ,Pennington DW.Unicompartmental knee arthroplasty in patients sixty years of age or younger.J Bone Joint Surg Am,2004,86:131-142.
[41]Berger RA,Meneghini RM,Jacobs JJ,et al.Results of unicompartmental knee arthroplasty at a minimum of ten years of follow up. J Bone Joint Surg Am,2005,87:999-1006.
[42]Isaac SM, BarkerKL,Danial IN,etal.Does arthroplasty type influence knee joint proprioception? A longitudinal prospective study comparing total and unicompartmental arthroplasty. The knee,2007,14:212-217
[43]Steele RG,Hutabarat S, Evans RL,et al.Survivorship of the stgeorgsled medial unicompartmental knee replacement beyond ten years. J Bone JointSurg(Br),2006,88-B: 1164-1168.
[44]O'Connor JJ, Goodfellow JW, Dodd CA. Development and clinical application of meniscal unicompartmental arthroplasty. J Proc Inst Mech Eng [H],2007,42:47-59.
[45]Hube R, Keim M J. Minimally invasive implantation in unicondylar arthroplasty. Orthopade.2007,36:1093-9
[46]Jenny JY.Navigated unicompartmental knee replacement.Orthopedics,2005;28:1263-1267
[47]Hernigou P,Deschamps GNavigation for Unicompartmental Arthroplasty.Techniques in Knee Surgery,2006,25:218-227
[48]张卫国,夏仁云.人工内侧单髁置换对膝关节伸屈过程中胫骨轴向旋转的影响.中国骨 与关节损伤杂志,2008,23(3)：208-209
[49]王晓峰.全膝关节置换术后膝关节的运动学分析.中国骨与关节损伤杂志，2005,20(5)：342-345
[50]Cobb AG, Kozinn SC, Scott RD:Unicompartmental or total knee replacement.:the patients preference. J Bone Joint Surg Br,1990,72(2):166-167
[51]Newman JH, Ackroyd CE, Shah NA. Unicompartmental or total knee replacement? five-years results of a prospective randomized trial of 102osteoarthritic knee with Unicompartmental arthroplasty.J Bone Joint Surg (Br),1989,80(9):862,
[52]Lizuar A, MareoL, Cebrina R. PeroPerative influence the range of movement after total knee arthorPlasty. J BoneJoint Surg(Br),1997,79:626 - 629.
[53]Btter MA, HartyLD, DvaisKE, etal. PrediCting rnage of motion after total knee arthroPlasty. J Bone
Joint Sugr(Am),2003,85:1278 - 1285.