后交叉韧带替代型和保留型全膝关节置换术的中期疗效比较

Comparison of intermediate term efficacy between posterior stabilized and posterior cruciateretaining total knee arthroplasty

目的评价后交叉韧带替代型（PS型）假体和后交叉韧带保留型（CR型）假体全膝关节置换术（TKA）的中期疗效，探讨两种不同假体置换术的临床相关问题。方法回顾性分析1992年5月至2006年5月收治84例（87膝）初次行TKA患者的临床资料，比较PS型假体41例（43膝）（PS组）和CR型假体43例（44膝）（CR组）的中期疗效。结果所有病例均获5～10（7．6±1．5）年的随访。两组均无感染、脱位或神经血管损伤并发症。但PS组有1例（1膝）术中骨折（股骨外髁后方）并发症，而CR组中无一例术中骨折并发症。PS组和CR组外侧支持带松解率分别为2．3％（1／43）和2．3％（1／44），术后6个月的前膝疼痛率分别为4．7％（2／43）和4．5％（2／44），在随访末期的前膝疼痛率均为0，两组比较差异无统计学意义（P〉0．05）。两组术后膝关节活动度和美国膝关节协会评分（KSS）比较差异无统计学意义（P〉0．05）。PS组和CR组在随访末期x线片上所显示的髌骨倾斜或半脱位率分别为2．3％（1／43）和2．3％（1／44），两组比较差异无统计学意义（P〉0．05）。两组随访末期x线片均未显示有任何假体周围的骨溶解、x线透亮带或假体松动迹象，无一例因假体松动或其他原因需行翻修术。结论PS型假体与cR型假体的中期疗效相似，但远期疗效有待进一步观察。

Objective To evaluate the intermediate term efficacy of posterior stabilized （PS） total knee arthroplasty （TKA） and posterior cruciate-retaining（CR） TKA and explore the clinical related problem. Methods The clinical data of 84 patients （87 knees） who treated with primary TKA from May 1992 to May 2006 were analyzed retrospectively. The intermediate term efficacy was compared between PS TKA （PS group, 41 cases with 43 knees） and CR TKA （CR group, 43 cases with 44 knees）. Results All the patients were followed up for 5-10（7.6 ± 1.5 ） years, no infection, dislocation or neurovascular injury occurred in both groups. But 1 knee occurred intraoperative posterolateral femoral condyle fracture in PS group. The lateral retinacular release rate was 2.3%（1/43） and 2.3%（1/44） in PS group and CR group, respectively. The incidence of anterior knee pain was 4.7%（2/43） and 4.5%（2/44） after 6 months surgery in PS group and CR group. The incidence of anterior knee pain was 0 at the end of follow-up in both groups. There was no significant difference in the lateral retinacular release rate and the incidence of anterior knee pain between two groups （P 〉 0.05）. The range of motion and American knee society score （KSS） was similar and no statistical difference was found between two groups（P 〉 0.05 ）. The incidence of patellar tilt or subluxation in X-ray was 2.3%（1/43） and 2.3%（1/44） at the end of follow-up in PS group and CR group. There was no significant difference between two groups （P 〉 0.05 ）. At the end of follow-up, no osteolysis, X-ray radiolucent zone and prosthesis loosening were found in both groups. There was no revision owing to loosening or other reasons. Conclusions The intermediate term efficacy of PS TKA and CR TKA is near a tie. However,the future efficacy still need further follow-up.