Cash R M, Gonzalez M H, Garst J, Barmada R, Stern S H
Department of Orthopaedics, The University of Illinois at Chicago, College of Medicine, 60612, USA.
Clin Orthop Relat Res. 1996 Oct(331):172-8.
To test the hypothesis that retaining the posterior cruciate ligament during total knee arthroplasty helps preserve the threshold of proprioceptive sensation, a machine was designed that permitted direct measurement of passive angular deflection from a resting point to the threshold of patient perception. Sixty patients with unilateral primary total knee arthroplasties were evaluated; 30 with posterior cruciate ligament retaining prostheses and 30 with posterior cruciate ligament substituting prostheses. All patients had a minimum postoperative followup of 1 year, a good or excellent result as defined by the Hospital for Special Surgery Knee Score, and no evidence of peripheral neuropathy. The gender and age distributions were equivalent between groups. The average threshold of perception for the posterior cruciate ligament retention group was 2.4 degrees. The average threshold of perception for the posterior cruciate ligament substitution group was also 2.4 degrees. Substitution or retention of the posterior cruciate ligament makes no clinical difference in proprioception as measured by threshold testing. This study provides new information for surgeons performing total knee arthroplasty to aid in the decision to retain or substitute the posterior cruciate ligament. Previous proprioception evaluation in patients with posterior cruciate ligament retaining versus posterior cruciate ligament substituting arthroplasties, using different testing methods, has revealed different results.
为了验证全膝关节置换术中保留后交叉韧带有助于维持本体感觉阈值这一假说，设计了一台机器，该机器能够直接测量从静止点到患者感知阈值的被动角度偏移。对60例单侧初次全膝关节置换患者进行了评估；其中30例使用保留后交叉韧带的假体，30例使用替代后交叉韧带的假体。所有患者术后至少随访1年，根据特种外科医院膝关节评分标准评定为良好或优秀结果，且无周围神经病变证据。两组间性别和年龄分布相当。保留后交叉韧带组的平均感知阈值为2.4度。替代后交叉韧带组的平均感知阈值也是2.4度。通过阈值测试测量，后交叉韧带的替代或保留在本体感觉方面没有临床差异。这项研究为进行全膝关节置换术的外科医生提供了新的信息，有助于他们决定保留或替代后交叉韧带。此前，采用不同测试方法对保留后交叉韧带与替代后交叉韧带的关节置换患者进行本体感觉评估，得出了不同的结果。
