Guo Lin, Yang Liu, Briard Jean Louis
Center for Joint Center, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
Zhonghua Wai Ke Za Zhi. 2008 Dec 1;46(23):1804-7.
To evaluate the long-term clinical result and reason of failure of posterior cruciate ligament(PCL) preserved prosthesis in a 15 years of follow-up study.
A case series of 153 patients (178 knees) undergoing total knee arthroplasty (TKA) with PCL preserved prosthesis between September 1990 and March 1992 in Center Medico-Chirurgical du Cedre was reported. All cases were evaluated with postoperative roentgenogram and Keen Society Clinical Scale. Measurement of X-ray included average hip knee ankle angle (HKA), deviation of HKA, alpha angle, beta angle, index of patella (AP/AT), proximal tibia angle (PTA), et al.
Thirty-one patients died and 4 patients were lost at the time follow-up. And 118 patients (125 knees) out of 153 patients were successfully followed-up. Fifteen years survival rate was 93.7%. And 11 knees were revised and the reasons were as follow: 9 aseptic loosening (7 knees with severe osteolysis, 2 knees with radiolucent line around tibial prosthesis); 1 recurvatum, 1 medial tibial plateau collapse. Postoperative score was 173 points. And 95.9% patients got good or excellent result. Comparing the clinical data of revised patients and un-revised patients, there were obvious difference between the following clinical data: varus and valgus angel of contralateral knee, beta angle of preoperative AP roentgenogram, preoperative and postoperative Knee Society Clinical Scale (P < 0.05).
PCL preserved prosthesis could recover the knee function to good or excellent result. Survival rate over 15 years is good. The way to sterilize the prosthesis could be the main reason for surgery failure. Few failures are related to PCL rupture. High wear rate and patellofemoral syndrome could be avoided by correct PCL and soft tissue balancing. Varus and valgus deformity of un-surgical knee and tibial varus deformity of surgical knee could be important factors for prosthesis failure.
通过一项15年的随访研究，评估保留后交叉韧带（PCL）的假体在全膝关节置换术（TKA）中的长期临床效果及失败原因。
报道了1990年9月至1992年3月在Cedre医疗中心接受保留PCL假体的全膝关节置换术的153例患者（178膝）的病例系列。所有病例均通过术后X线片和膝关节协会临床评分进行评估。X线测量包括平均髋膝踝角（HKA）、HKA偏差、α角、β角、髌骨指数（AP/AT）、胫骨近端角（PTA）等。
31例患者死亡，4例患者在随访时失访。153例患者中的118例（125膝）成功随访。15年生存率为93.7%。11膝进行了翻修，原因如下：9例无菌性松动（7膝伴有严重骨溶解，2膝胫骨假体周围有透亮线）；1例膝反屈，1例胫骨内侧平台塌陷。术后评分为173分。95.9%的患者获得了良好或优秀的结果。比较翻修患者和未翻修患者的临床数据，以下临床数据之间存在明显差异：对侧膝关节的内翻和外翻角度、术前前后位X线片的β角、术前和术后膝关节协会临床评分（P<0.05）。
保留PCL的假体可使膝关节功能恢复至良好或优秀的结果。15年以上的生存率良好。假体的灭菌方式可能是手术失败的主要原因。少数失败与PCL破裂有关。通过正确的PCL和软组织平衡可避免高磨损率和髌股综合征。未手术膝关节的内翻和外翻畸形以及手术膝关节的胫骨内翻畸形可能是假体失败的重要因素。
