Straw R, Kulkarni S, Attfield S, Wilton T J
Derbyshire Royal Infirmary, Derby, England, UK.
J Bone Joint Surg Br. 2003 Jul;85(5):671-4.
We report the results of a prospective randomised trial which assessed the role of the posterior cruciate ligament (PCL) following total knee replacement (Genesis I; Smith and Nephew, Memphis, Tennessee). Over a four-year period, 211 patients underwent total knee replacement by the senior author (TJW). They were randomised at surgery to have the PCL either retained, excised or substituted with a posterior stabilised insert. If it was not possible to retain the ligament due to soft-tissue imbalance, it was released from its tibial insertion until suitable tension was obtained. This created a fourth group, those who were intended preoperatively to have the ligament retained, but in whom it was partially released as a result of findings at the time of surgery. All patients were evaluated using the Knee Society rating system (adapted from Insall). A total of 188 patients (212 knees) was available for follow-up at a mean of 3.5 years after surgery. Preoperatively, there was a varus deformity in 191 knees (90%) and a valgus deformity in 21 (10%). There were no statistical differences in the knee or function scores or the range of movement between the excised, retained and substituted groups. There were, however, significantly worse knee and function scores in the group in whom the PCL was released (p = 0.002).
我们报告了一项前瞻性随机试验的结果，该试验评估了全膝关节置换术（Genesis I；史赛克公司，田纳西州孟菲斯）后后交叉韧带（PCL）的作用。在四年期间，211例患者接受了资深作者（TJW）进行的全膝关节置换术。他们在手术时被随机分组，PCL要么保留、切除，要么用后稳定型衬垫替代。如果由于软组织失衡无法保留韧带，则将其从胫骨附着处松解，直到获得合适的张力。这形成了第四组，即那些术前打算保留韧带，但由于手术时的发现而部分松解的患者。所有患者均使用膝关节协会评分系统（改编自英萨尔评分系统）进行评估。共有188例患者（212个膝关节）在术后平均3.5年时可供随访。术前，191个膝关节（90%）存在内翻畸形，21个膝关节（10%）存在外翻畸形。切除组、保留组和替代组之间的膝关节评分、功能评分或活动范围无统计学差异。然而，PCL被松解的组的膝关节评分和功能评分明显更差（p = 0.002）。
