Orthopaedic Department, Center for Musculoskeletal Surgery, Charité, University Hospital Berlin, Charitéplatz 1, 10117 Berlin, Germany.
Knee Surg Sports Traumatol Arthrosc. 2012 Jun;20(6):1083-6. doi: 10.1007/s00167-011-1696-5. Epub 2011 Oct 11.
There are two different techniques for retaining the posterior cruciate ligament (PCL) in total knee arthroplasty. The attachment of the PCL can be spared during resection of the tibial plateau, so that a small posterior bone block remains. In contrast to this, many surgeons resect the tibial plateau completely and detach a part of the tibial PCL attachment from the resected material. The objective of this study was to determine how big this part is in an anatomical resection of the tibial plateau with 0° and 7° slope and whether it is gender-dependent.
Two hundred consecutive patients who had undergone MRI of a knee joint were included. Patients were excluded if they were younger than 18 years or had dysplasia of the knee joint or injuries of the posterior cruciate ligament. The MRIs of 182 knees that fulfilled the inclusion criteria were analysed. For each knee, an anatomical tibial resection with 0° and 7° posterior slope was simulated, and the parts of the tibial PCL attachment that were resected and retained were determined.
Given a measured tibial resection with 0° slope, 45 ± 28% of the tibial PCL attachment was removed in the men, compared with 46 ± 30% in the women (n.s.). Given a resection with 7° slope, 69 ± 24% of the tibial PCL attachment was removed in the men and 67 ± 25% in the women. This corresponded to a complete resection in 19 men (20%) and 16 women (24%).
Independently of gender, the anatomical resection of the tibia leads to the removal of a considerable part of the tibial PCL attachment, if this is not spared in the form of a bone block during resection. This becomes increasingly relevant with higher posterior slope of the resection plane. In the case of a cruciate-retaining surgical technique, the retention of the posterior tibial cortical bone in the area of attachment of the PCL is therefore strongly recommended.
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在全膝关节置换术中，有两种不同的方法保留后交叉韧带（PCL）。在切除胫骨平台时，可以保留PCL 的附着处，因此会留下一小部分后侧骨块。与此相反，许多外科医生会完全切除胫骨平台，并从切除的材料中分离出一部分胫骨 PCL 附着处。本研究的目的是确定在 0°和 7°坡度的胫骨平台解剖切除中，这个部分有多大，以及它是否与性别有关。
纳入了 200 例连续接受膝关节 MRI 检查的患者。如果患者年龄小于 18 岁、膝关节发育不良或后交叉韧带损伤，则排除在外。分析了符合纳入标准的 182 个膝关节的 MRI。对于每个膝关节，模拟了 0°和 7°后斜率的解剖胫骨切除，并确定了切除和保留的胫骨 PCL 附着处的部分。
在测量的 0°斜率胫骨切除中，男性中有 45±28%的胫骨 PCL 附着处被切除，而女性中有 46±30%（无统计学意义）。在 7°斜率的切除中，男性中有 69±24%的胫骨 PCL 附着处被切除，女性中有 67±25%。这相当于 19 名男性（20%）和 16 名女性（24%）进行了完全切除。
无论性别如何，如果在切除时不以骨块的形式保留胫骨平台，解剖切除胫骨会导致相当一部分胫骨 PCL 附着处被切除。随着切除平面后斜率的增加，这种情况变得越来越重要。在保留交叉韧带的手术技术中，因此强烈建议在 PCL 附着处保留胫骨后皮质骨。
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