后交叉韧带保留型膝关节置换术中完整保留后交叉韧带的临床效果

Clinical effect of intact posterior cruciate ligament retaining in PCL retaining total knee arthroplasty

目的评价后交叉韧带保留型膝关节置换术(CR TKA)术中完整保留后交叉韧带(PCL)的临床疗效。方法回顾性分析北京朝阳医院骨科2016年6月至2018年12月收治的386例符合纳入标准并行单侧CR TKA患者的临床资料,其中男124例,女262例。患者在术前均行影像学检查并排除关节外畸形。术中进行等量截骨及常规软组织松解技术,PCL的两个束支完整保留。选择术前,术后3个月、6个月以及12个月对患者进行临床评价,观察指标包括膝关节活动度、膝关节临床评分系统(包括临床评分以及功能评分)以及屈膝90°位时膝关节前后向最大位移距离,并记录患者术后并发症情况及影像学检查结果。采用单因素方差分析对手术前后指标进行统计学分析。结果由于各种原因共失访患者98例,最终纳入研究合计288例,年龄53~86岁,平均(64.8±8.7)岁,随访时间持续14~31个月,平均(21.2±4.3)个月。患者术后3个月、6个月以及12个月的膝关节活动度、膝关节临床评分系统较术前均有较大提高,差异有统计学意义(P<0.01);而术后6个月与12个月观察点屈膝90°位时膝关节前后向最大位移距离变化不大,差异无统计学意义(P>0.05)。4例患者术后切口持续渗出、1例患者出现切口裂开,均早期清创处理后治愈,未发现切口皮肤坏死、下肢深静脉血栓形成、术后感染等并发症,影像学检查未见假体松动、垫片过度磨损、脱位病例。结论CR TKA术中完整保留PCL不会影像假体的放置及关节活动,反而会增加膝关节的稳定性,早期恢复关节功能。

Objective To evaluate the clinical efficacy of entire posterior cruciate ligament(PCL)retaining during cruciate-retaining total knee arthroplasty(CR TKA).Methods The clinical data of 386 patients meeting the inclusion criteria and treated with unilateral CR TKA in the orthopedics department of Beijing Chaoyang Hospital from June 2016 to December 2018 were retrospectively analyzed,including 124 males and 262 females.All cases underwent preoperative imaging examination and excluded extra-articular deformities.During the operation,the equivalent osteotomy and conventional soft tissue release were performed,and the two fascicles of PCL were completely preserved.The clinical evaluation was performed before surgery and in postoperative 6,12,and 24 months.The observation indicators included the range of joint motion,Knee Joint Clinical Rating System(including clinical and functional scores)and maximum anteroposterior(AP)displacement of the knee at 90°of knee flexion,and postoperative complications and imaging examination results were recorded.The one-way anova was used for conducting the statistical analysis of the indicators before and after the operation.Results A total of 98 cases were lost to follow-up due to various reasons,and a total of 288 cases were eventually included in the study,with an average age of(64.8±8.7)years old,and a follow-up duration of(14-31)months[mean(21.2±4.3)months].The range of knee joint motion and the knee joint clinical scoring system in postoperative 3,6 and 12 months were significantly increased compared with those before surgery,and the differences were statistically significant(P<0.01).However,the maximum anteroposterior displacement distance when bending the knee at 90°in postoperative 6,12 months was not significantly changed,and the difference was not statistically significant(P>0.05).Postoperative incision exudation continued in 4 cases,the incision was disrupted in 1 case,and all cases conducted the early debridement and cured.No complications such as skin necrosis of incision,deep vein thrombosis of lower limbs and postoperative infection were found.No cases of prosthesis loosening,excessive wear of gasket or dislocation were found in the imaging examination.Conclusion The complete retention of PCL during the operation of CR TKA will not affect the placement of prosthesis and joint movement,on the contrary which will increase the stability of the knee joint,and early recovery of joint function.