Scott W N, Rubinstein M, Scuderi G
Department of Orthopedics, Lenox Hill Hospital, New York City.
J Bone Joint Surg Am. 1988 Sep;70(8):1163-73.
From 1979 to 1984, eighty patients (119 knees) were arbitrarily selected for treatment with knee arthroplasty in which a posterior cruciate-substituting replacement was used. The average age of the forty-nine women and thirty-one men was 66.9 years (range, twenty-two to eighty-four years). Sixty-one right and fifty-eight left knees were operated on, and bilateral replacement was performed in thirty-nine of the eighty patients. The diagnosis was osteoarthritis in fifty-eight patients (eighty-eight knees), rheumatoid arthritis in fourteen patients (twenty-two knees), osteonecrosis in three patients (four knees), and traumatic arthritis secondary to a fracture of the tibia or femur in five patients (five knees). The average preoperative score on The Hospital for Special Surgery knee-rating scale was 47.5 points, and the average range of motion preoperatively was 88 degrees (range, 30 to 140 degrees). Of the 119 knees, eighty-seven had a varus alignment (maximum, 35 degrees) before knee replacement. After follow-up of two to eight years, the average score on The Hospital for Special Surgery scale was 90 points, and the average range of motion was 107 degrees. Of the 119 knees, 83 per cent were rated as excellent; 15 per cent, as good; none, as fair; and 2 per cent, as poor. Radiolucencies of one millimeter were present in 76 per cent of the knees; of two millimeters, in 7 per cent; and of three millimeters, in 3 per cent. No statistically significant correlation between radiolucencies and the clinical result was found. The results in knees of patients who had rheumatoid arthritis were not as good as those in knees of patients who had other diagnoses (F = 11.44). Our experience suggested that the posterior cruciate-substituting design provides more motion than do the cruciate-sacrificing surface-replacement designs, with no deleterious effects. The rate of infection (1.6 per cent) after these procedures, which were carried out in a standard operating theater with vertical airflow, was equivalent to that in other published series in which rooms with laminar airflow were used. Patients who had a bilateral procedure did as well as those who had a unilateral replacement, but they required approximately 3.5 more units of blood.
1979年至1984年，随机选择80例患者（119个膝关节）接受膝关节置换术治疗，采用后交叉韧带替代型假体。49名女性和31名男性的平均年龄为66.9岁（范围为22至84岁）。对61个右膝和58个左膝进行了手术，80例患者中有39例行双侧置换。诊断为骨关节炎58例（88个膝关节），类风湿关节炎14例（22个膝关节），骨坏死3例（4个膝关节），胫骨或股骨骨折继发创伤性关节炎5例（5个膝关节）。术前在特种外科医院膝关节评分量表上的平均得分为47.5分，术前平均活动范围为88度（范围为30至140度）。119个膝关节中，87个在膝关节置换术前呈内翻畸形（最大35度）。经过2至8年的随访，特种外科医院量表的平均得分为90分，平均活动范围为107度。119个膝关节中，83%被评为优秀；15%为良好；无一般；2%为差。76%的膝关节存在1毫米的透亮线；2毫米的占7%；3毫米的占3%。未发现透亮线与临床结果之间存在统计学显著相关性。类风湿关节炎患者膝关节的结果不如其他诊断患者膝关节的结果好（F = 11.44）。我们的经验表明，后交叉韧带替代型设计比牺牲交叉韧带的表面置换型设计提供更多活动度，且无有害影响。在具有垂直气流的标准手术室中进行这些手术后的感染率（1.6%）与使用层流气流房间的其他已发表系列中的感染率相当。接受双侧手术的患者与接受单侧置换的患者情况相同，但他们需要多约3.5个单位的血液。
