全膝关节置换术中切除后交叉韧带和松解内侧副韧带浅层对关节间隙的影响

Effect of PCL resection vs. SMCL releasing on joint gaps in TKA surgery

目的比较全膝关节置换术(total knee arthroplasty,TKA)中切除后交叉韧带和松解内侧副韧带浅层对膝关节间隙的影响。方法 2013年4月-2014年5月因膝关节重度骨关节炎致膝内翻畸形在我院行单膝关节置换患者83例,随机分为A组和B组。术中进行软组织平衡过程中,A组顺序使用切除后交叉韧带和松解内侧副韧带浅层两种方法,B组仅使用松解内侧副韧带浅层一种方法。使用关节间隙测量器分别在上述处理前后测量关节在伸膝(0°)和屈膝(90°)时的内、外侧间隙大小及上述处理后的张开幅度。结果 A组中,经过上述两种方法处理后伸膝间隙差异均无统计学意义,屈膝位内、外侧间隙均显著增大,其中切除后交叉韧带使屈曲内、外侧间隙分别由(15.55±0.42)mm和(19.58±0.53)mm增大至(16.88±0.53)mm和(20.60±0.63)mm(t=5.514、2.985,P=0.000、0.011)。上述方法对内、外侧间隙的影响差异无统计学意义。B组中,松解内侧副韧带浅层后,伸直和屈曲位的关节内侧间隙分别由(18.67±0.54)mm和(15.62±0.68)mm增加至(19.53±0.53)mm和(16.50±0.70)mm(t=3.180、3.705,P=0.007、0.002),且对屈曲间隙和伸直间隙的影响无明显差异。A、B组对比,两种方法联合使用(A组)时屈膝内、外侧间隙张开幅度明显大于单独使用松解内侧副韧带浅层(B组)(t=3.949、5.687,P=0.002、0.000),而伸膝间隙的张开幅度并无显著差异。切断后叉的基础上再行松解内侧副韧带浅层(A组)对比单独松解内侧副韧带浅层(B组),前者的屈膝间隙张开幅度明显大于后者(t=2.880、3.088,P=0.012、0.007),伸膝间隙的张开幅度差异不明显。结论在膝关节置换术中,切除后交叉韧带主要影响屈、伸膝间隙平衡。松解内侧副韧带浅层主要影响内、外侧间隙平衡。在术中可根据不同情况单独或联合使用上述技术。

Objective To compare the effects of posterior cruciate ligament （PCL） resection vs. shallow medial collateral ligament （SMCL） releasing on joint gaps in the total knee arthroplasty （TKA） surgery.Methods From April 2013 to May 2014, there were 83 osteoarthritis patients with varus knee underwent unilateral TKA in our department. Patients were randomly divided into two groups, patients in group A underwent both PCL resection and SMCL releasing in surgery,while those in group B underwent only SMCL releasing. The joint gaps before and after surgical treatment and the related data were measured and analyzed.Results There were no statistical differences in extension gap and medial and lateralflexion gap between these two surgical treatments in group A （P〉0.05）, while PCL resection increased medial and lateralflexion gap significantly [（15.55±0.42） mmvs （16.88±0.53） mm,t=5.514, P=0.000; （19.58±0.53） mm vs. （20.60±0.63） mm, t=2.985,P=0.011]. In group B, SMCL releasing showed significant differences on medial gap in both extension andflexion gaps [（18.67±0.54） mmvs （19.53±0.53） mm,t=3.180,P=0.007; （15.62±0.68） mm vs （16.50±0.70） mm,t=3.705,P=0.002], but it showed no differences on lateral gap. The combination of PCL resection and SMCL releasinghad more significant influence on range of gap opening than doing SMCL releasing alone in group B （t=3.949,P=0.002;t=5.687, P=0.000）, while no significant difference was found in extension gap. Doing SMCL releasing after PCL resection in group A had more significant influence than doing SMCL releasing without PCL resection in group B onflexion gap （t=2.880,P=0.012;t=3.088,P=0.007） with no significant difference in extension gap.Conclusion PCL resection has influence on the balance offlexion and extension gap during TKA surgery, while SMCL releasing mainly has influence on the balance of medial and lateral gap, which suggests that whether using the combination of these two methods or one method alone depends on different situations during surgery.