全膝关节置换术后交叉韧带切除对关节结构及术后短期功能的影响

Effect of cruciate ligament resection on joint structure and short-term function after total knee arthroplasty

目的探讨全膝关节置换术后交叉韧带切除对屈伸间隙、屈曲挛缩畸形等关节结构以及术后膝关节活动度、下肢力线等功能的影响。方法以2017年4月至2018年9月收治的77例膝骨关节炎患者作为研究对象,所有患者均接受全膝关节置换术后交叉韧带切除,术中测量切除前后内外侧伸展/屈曲间隙,术后1周评估膝关节活动度及下肢力线。结果术后患者的内/外侧伸展间隙和内/外侧屈曲间隙均较术前明显增加(P<0.05);术后内外侧屈曲间隙差值明显高于内外侧伸展间隙差值(P<0.05)。患者平均屈曲挛缩畸形(FFD)(3.96±2.60)°,相比术前平均FFD(6.95±3.65)°明显降低(P<0.05),并且术前不同畸形程度患者术后FFD角度均明显低于术前(P<0.05)。经Spearman相关性分析显示,FFD变化水平与术前畸形程度呈正相关(r=0.788, P<0.01)。术后1周患者关节活动度(ROM)相比术前明显增加,下肢力线角度相比术前明显降低(P<0.05)。Spearman相关性分析显示,内外侧屈曲间隙差值、内外侧伸展间隙差值与ROM、下肢力线均无相关性(P>0.05)。结论全膝关节置换术非保留型后交叉韧带假体可有效改善屈曲畸形,但存在因屈曲-伸展水平不一所致的不同程度内侧屈曲松弛,然而这对术后短期关节功能活动及稳定性并无影响。

【Objective】To investigate the effect of cruciate ligament resection on the joint structure such as flexion and extension space,flexion contracture deformity,range of motion of knee joint and lower limb function after total knee arthroplasty.【Methods】From April 2017 to September 2018,77 patients with knee osteoarthritis were selected as the research objects.All patients underwent cruciate ligament resection after total knee arthroplasty.The internal and external extension/flexion spaces before and after resection were measured during the operation.The range of motion of knee joint and lower limb force line were evaluated one week after operation.【Results】The medial/lateral extension space and medial/lateral flexion space were significantly increased after operation(P<0.05);the difference of medial/lateral flexion space was significantly higher than that of medial/lateral extension space after operation(P<0.05).The average FFD of patients was(3.96±2.60)°,which was significantly lower than that of preoperative(6.95±3.65)°(P<0.05),and the postoperative FFD angle of patients with different degree of deformity before operation was significantly lower than that before operation(P<0.05).Spearman correlation analysis showed that FFD level was positively correlated with preoperative deformity degree(r=0.788,P<0.01).One week after operation,the ROM of patients was significantly increased compared with that before operation,and the lower limb force line angle was significantly decreased compared with that before operation,the differences were statistically significant(P<0.05).Spearman correlation analysis showed that there was no correlation between the difference of internal and external flexion gap,the difference of internal and external extension gap and ROM,lower limb force line(P>0.05).【Conclusion】Non-reserved posterior cruciate ligament prosthesis in total knee arthroplasty can effectively improve the flexion deformity,but there are different degrees of medial flexion relaxation due to different flexion exte nsion levels.However,it has no effect on the short-term postoperative functional activity and stability.