Zhang Bo, Lin Yuan, Ren Shixiang, Chen Tong, Zhao Xiaoxiong, Yu Yang
Department of Orthopedics, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021 Jan 15;35(1):51-57. doi: 10.7507/1002-1892.202007021.
To compare the effectiveness of partial versus intact posterior cruciate ligament (PCL)-retaining in total knee arthroplasty (TKA) with cruciate-retaining (CR) prosthesis.
A total of 200 patients with osteoarthritis, who met the selection criteria and proposed unilateral TKA with CR prosthesis, were included in the study and randomly assigned into two groups ( =100). The patients were treated with intact retention of the double bundles of PCL in intact group and with partial resection of the anterior lateral bundle of PCL and the anterior bone island at the time of intraoperative tibial osteotomy in partial group. Patients with lost follow-up and re-fracture were excluded, and 84 cases in partial group and 88 cases in intact group were included in the final study. There was no significant difference between the two groups ( >0.05) in terms of gender, age, body mass index, course and grade of osteoarthritis, preoperative varus deformity of knee joint, flexion contracture, range of motion, clinical and functional scores of Knee Society Score (KSS). The operation time, wound drainage volume during 24 hours after operation, visual analogue scale (VAS) score at 24 hours after operation, range of motion of knee joint, clinical and functional scores of KSS, and the anteroposterior displacement of knee joint at 30° and 90° flexion positions were compared between the two groups.
There was no significant difference between the two groups in operation time, wound drainage volume during 24 hours after operation, and VAS score at 24 hours after operation ( >0.05). Patients in both groups were followed up after operation. The follow-up time was 25-40 months (mean, 30.2 months) in intact group and 24-40 months (mean, 31.8 months) in partial group. There was no significant difference in the range of motion and clinical scores of KSS between the two groups at 6, 12, and 24 months after operation ( >0.05). The functional scores of KSS were significantly higher in intact group than in partial group ( <0.05). There was no significant difference between the two groups in the anteroposterior displacement of knee joints at 30° flexion position at 6, 12, and 24 months after operation ( >0.05). When the knee was at 90° flexion position, there was no significant difference between the two groups at 6 and 12 months after operation ( >0.05), but the intact group was significantly smaller than partial group at 24 months after operation ( <0.05). Postoperative incision continued exudation in 4 patients (2 cases of partial group and 2 cases of intact group), and incision debridement in 2 patients (1 case of partial group and 1 case of intact group). No prosthesis loosening, excessive wear, or dislocation of gasket was found during follow-up.
The double bundle of PCL plays an equally important role in maintaining the stability of the knee joint, and the integrity of PCL should be kept as much as possible when TKA is performed with CR prosthesis.
比较在采用保留交叉韧带（CR）假体的全膝关节置换术（TKA）中，保留部分后交叉韧带（PCL）与保留完整PCL的有效性。
本研究共纳入200例符合入选标准且拟行单侧CR假体TKA的骨关节炎患者，并将其随机分为两组（每组n = 100）。完整组患者术中完整保留PCL双束，部分组患者在胫骨截骨时对PCL前外侧束及前方骨岛进行部分切除。排除失访及再次骨折患者，最终纳入部分组84例，完整组88例。两组患者在性别、年龄、体重指数、骨关节炎病程及分级、术前膝关节内翻畸形、屈曲挛缩、活动范围、膝关节协会评分（KSS）的临床及功能评分方面差异均无统计学意义（P > 0.05）。比较两组患者的手术时间、术后24小时伤口引流量、术后24小时视觉模拟评分（VAS）、膝关节活动范围、KSS临床及功能评分，以及膝关节在30°和90°屈曲位时的前后移位情况。
两组患者的手术时间、术后24小时伤口引流量及术后24小时VAS评分差异均无统计学意义（P > 0.05）。两组患者术后均进行随访。完整组随访时间为25 - 40个月（平均30.2个月），部分组随访时间为24 - 40个月（平均31.8个月）。术后6、12和24个月时，两组患者的膝关节活动范围及KSS临床评分差异均无统计学意义（P > 0.05）。完整组KSS功能评分显著高于部分组（P < 0.05）。术后6、12和24个月时，两组患者膝关节在30°屈曲位时的前后移位差异均无统计学意义（P > 0.05）。当膝关节处于90°屈曲位时，术后6和12个月两组间差异无统计学意义（P > 0.05），但术后24个月时完整组显著小于部分组（P < 0.05）。术后有4例患者切口持续渗液（部分组和完整组各2例），2例患者切口清创（部分组和完整组各1例）。随访期间未发现假体松动、过度磨损或垫片脱位。
PCL双束在维持膝关节稳定性方面发挥着同等重要的作用，在采用CR假体行TKA时应尽可能保留PCL的完整性。
