Mayne Aiw, Harshavardhan H P, Johnston L R, Wang W, Jariwala A
Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, Dundee, Scotland , UK.
Ann R Coll Surg Engl. 2017 Nov;99(8):602-606. doi: 10.1308/rcsann.2017.0086. Epub 2017 Jun 27.
INTRODUCTION Debate has persisted for many years about whether to sacrifice or replace the posterior cruciate ligament when performing total knee arthroplasty. A paucity of long-term follow-up studies comparing outcomes between cruciate-retaining and posterior-stabilised knees exist. We aimed to compare results at ten-year follow-up. METHODS A matched paired study comparing a cohort of 107 Zimmer Nexgen® Cruciate Retaining (CR) patients with a cohort of 107 Nexgen Posterior-Stabilised (PS) knees matched for age, sex, body mass index and preoperative American Knee Society score was undertaken. All patients underwent independent clinical assessment and knee society scoring preoperatively and at 1, 3, 5, 7 and 10 years postoperatively. RESULTS Fifty-three patients (49.5%) in the CR group and 44 patients (41.1%) in the PS group were alive at 10-year follow-up. There were no significant differences between the CR and PS groups with regards to functional assessment (P = 0.95), overall range of movement (P = 0.46) or patient satisfaction (P = 1.0) at 10 years. However, there was a significantly better score improvement in range of movement in PS knees compared with CR knees (P = 0.027). There were six revisions (5.6%) in the PS group and 1 (0.93%) in the CR group (P = 0.12). Both CR and PS knees showed excellent survivorship with no significant difference at 10 years (P = 0.068). CONCLUSIONS There were no significant differences in functional score, overall range of motion or patient satisfaction between the Nexgen cruciate retaining and posterior stabilised total knee arthroplasty at 10-year follow-up. However, PS knees had a greater score improvement in range of motion compared with CR knees.
引言
关于在进行全膝关节置换术时是否保留或替换后交叉韧带,多年来一直存在争议。目前缺乏比较保留交叉韧带膝关节和后稳定型膝关节长期随访结果的研究。我们旨在比较十年随访的结果。
方法
进行了一项配对研究,将107例使用Zimmer Nexgen®保留交叉韧带(CR)的患者与107例年龄、性别、体重指数和术前美国膝关节协会评分相匹配的Nexgen后稳定型(PS)膝关节患者进行比较。所有患者在术前以及术后1年、3年、5年、7年和10年接受独立的临床评估和膝关节协会评分。
结果
在10年随访时,CR组有53例患者(49.5%)存活,PS组有44例患者(41.1%)存活。在10年时,CR组和PS组在功能评估(P = 0.95)、总体活动范围(P = 0.46)或患者满意度(P = 1.0)方面没有显著差异。然而,与CR膝关节相比,PS膝关节的活动范围评分改善明显更好(P = 0.027)。PS组有6例翻修(5.6%),CR组有1例翻修(0.93%)(P = 0.12)。CR和PS膝关节均显示出良好的生存率,10年时无显著差异(P = 0.068)。
结论
在10年随访时,Nexgen保留交叉韧带和后稳定型全膝关节置换术在功能评分、总体活动范围或患者满意度方面没有显著差异。然而,与CR膝关节相比,PS膝关节在活动范围方面的评分改善更大。