PCL在TKA中保留程度及可行性研究

Study on the Degree of Retention and Feasibility of PCL in TKA

目的研究国人后稳定型全膝关节置换术(PS-TKA)后交叉韧带(PCL)残留量及其影响因素,探讨国人行CR型TKA的可行性及术中技术要领。方法选取2016年5月~2018年8月行PS-TKA患者52例,比较不同性别、身高患者PCL保留比例;收集患者胫骨平台截骨前后径、内外径、PCL保留比例、胫骨长度,分析其影响因素及相关性。结果所有患者均完成手术,获得定期随访,平均随访时间(12.00±0.50)个月;不同性别患者的PCL保留量比较,差异无统计学意义(P>0.05);不同身高患者的PCL保留量比较,差异有统计学意义(P<0.05);PCL保留比例与身高存在线性关系,直线回归方程y=6.32+0.43x,回归系数有统计学意义(P=0.003),其中身高为171 cm,PCL保留比例50%;身高157 cm,PCL保留比例30%;PCL保留比例与胫骨平台前后径、内外径、胫骨长度呈正相关(P<0.05)。结论国人行TKA中,身高对于PCL保留比例有影响,对于身高低于171 cm的患者,PCL保留比例在50%以下,普遍偏低,术后残留PCL不能发挥其正常生理功能,临床医师应充分掌握针对此类患者的截骨技术,以提高手术效果。

Objective To investigate the residual amount of posterior cruciate ligament(PCL)and its influencing factors after stable total knee arthroplasty(PS-TKA)in Chinese,and to explore the feasibility and technical essentials of CR-type TKA.Methods A total of 52 patients with PS-TKA from May 2016 to August 2018 were enrolled.The proportion of PCL retention in patients with different genders and heights was compared.The diameters of the tibiofibular anterior and posterior humerus,the percentage of PCL retention,and the length of the tibia were collected factors and relevance.Results All patients underwent surgery and received regular follow-up.The average follow-up time was(12.00±0.50)months.There was no significant difference in PCL retention between different genders(P>0.05).The PCL retention of patients with different heights was statistically significant(P<0.05).There was a linear relationship between PCL retention and height.The linear regression equation was y=6.32+0.43x,and the regression coefficient was statistically significant(P=0.003),in which the height was 171cm,the PCL retention ratio was 50%,the height was 157cm,and the PCL retention ratio was 30%.The PCL retention ratio was positively correlated with the anteroposterior diameter,inner and outer diameter,and tibia length of the tibial plateau(P<0.05).Conclusion In the TKA of Chinese people,the height has an effect on the retention ratio of PCL.For patients with height less than 171 cm,the retention rate of PCL is below 50%,which is generally low.Postoperative residual PCL can not exert its normal physiological function.Clinicians should fully Master the osteotomy technique for such patients to improve the operation effect.