Center for Hip and Knee Surgery, 1199 Hadley Road, Mooresville, Indiana 46158-1797, USA.
Bone Joint Res. 2012 Apr 1;1(4):64-70. doi: 10.1302/2046-3758.14.2000024. Print 2012 Apr.
The purpose of this study was to examine the effect of posterior cruciate ligament (PCL) retention, PCL recession, and PCL excision during cruciate-retaining total knee replacement.
A total of 3018 anatomic graduated component total knee replacements were examined; 1846 of these retained the PCL, 455 PCLs were partially recessed, and in 717 the PCL was completely excised from the back of the tibia.
Clinical scores between PCL groups favored excision for flexion (p < 0.0001), and recession and retention for stairs (p < 0.0001). There was a mild difference in long-term all-cause aseptic survivorship between PCL-retained (96.4% at 15 years) combined with PCL-recessed groups (96.6% at 15 years) when compared with the PCL-excised group (95.0% at 15 years) (p = 0.0411, Wilcoxon; p = 0.0042, log-rank), as well as tibial or femoral loosening, which reported prosthesis survival of 97.8% at 15 years for PCL-retained knees, 98.2% for recessed knees, and 96.4% for excised knees (p = 0.0934, Wilcoxon; p = 0.0202, log-rank).
Despite some trade off in clinical performance, if the PCL is detached at the time of operation, conversion to a posterior-stabilised prosthesis may not be necessarily required as long as stability in the anteroposterior and coronal planes is achieved.
本研究旨在探讨保留后交叉韧带（PCL）、PCL 后移和切除 PCL 对保留后交叉韧带的全膝关节置换的影响。
共检查了 3018 例解剖学梯度组件全膝关节置换，其中 1846 例保留了 PCL，455 例 PCL 部分后移，717 例 PCL 完全从胫骨后切除。
PCL 组的临床评分有利于切除组的屈曲（p < 0.0001），而保留组和后移组有利于上楼梯（p < 0.0001）。与 PCL 切除组（15 年时为 95.0%）相比，PCL 保留（15 年时为 96.4%）与 PCL 后移（15 年时为 96.6%）相结合的长期全因无菌生存率有轻微差异（p = 0.0411，Wilcoxon；p = 0.0042，log-rank），以及胫骨或股骨松动，报告 15 年时 PCL 保留膝关节的假体生存率为 97.8%，后移膝关节为 98.2%，切除膝关节为 96.4%（p = 0.0934，Wilcoxon；p = 0.0202，log-rank）。
尽管在临床性能上存在一些权衡，如果在手术时 PCL 已分离，则只要在前后和冠状平面上达到稳定性，不一定需要转换为后稳定型假体。
