Coronal laxity in extension in vivo after total knee arthroplasty

We performed stress arthrometric studies on 77 knees (71 patients) with total knee arthroplasty to determine the presence and magnitude of femoral abduction and adduction in knee extension. A total of 53 knees (49 patients) had posterior cruciate ligament-retaining (PCLR) prostheses, and 24 (22 patients) had PCL-substituting (PCLS) prostheses. The selected patients had successful arthroplasties with no clinical complications a minimum of 5 years after primary surgery. Each patient was subjected to a successive abduction and adduction stress test at 0°–20° of flexion using a Telos arthrometer. The mean values for abduction and adduction were 4.8° and 4.5° with a PCLR prosthesis, respectively, and 4.6° and 4.0° with a PCLS prosthesis. There were no statistical differences between PCLR and PCLS knees. The results suggest that approximately 4° of laxity in these directions is suitable in total knee arthroplasty for a satisfactory clinical outcome 5–9 years after surgery.     

Effect of flexion angle on coronal laxity in patients with mobile-bearing total knee arthroplasty prostheses

Proper soft tissue tension is one of the important factors in mobile-bearing total knee arthroplasty (TKA). We evaluated varus/valgus laxities, particularly at flexion, which is a key factor in reducing the risk of subluxation and dislocation of bearings to assess the effect that the flexion angle and the presence or absence of the posterior cruciate ligament (PCL) have on laxity in patients with low-contact stress (LCS) prostheses of the PCL-retaining (24 patients, 24 knees) and PCL-sacrificing (24 patients, 24 knees) type designs during extension and flexion. Both types of prosthesis had about 4° laxity at extension and 3° at flexion. PCL-retaining prostheses had significantly less laxity at flexion than at extension (P = 0.0004 in varus, P = 0.0043 in valgus). For good clinical outcomes following TKA, 3°–4° laxity in the varus and valgus orientations is recommended. In addition, the PCL might be involved in flexion and could affect varus/valgus laxity in PCL-retaining prostheses.     

增加胫骨平台后倾角度、后交叉韧带部分松解对全膝关节置换术后膝关节运动影响的实验研究

目的通过增加胫骨平台后倾角度或后交叉韧带（PCL）部分松解对全膝关节置换术（TKA）中屈曲间隙过紧进行处理,分析这两种方法对TKA术后膝关节运动学的影响。方法测量6例新鲜尸体膝关节标本在完整状态下、正常TKA、屈曲间隙过紧、增加胫骨平台后倾角以及PCL部分松解TKA术后膝关节屈曲0°、30°、60°、90°、120°时的前后松弛度、内外翻松弛度、旋转松弛度及最大屈曲度。结果屈曲过紧TKA与正常TKA相比,在屈曲30°、60°、90°和120°时前后松弛度、内外翻松弛度及旋转松弛度均显著较小（P〈0．05）。与屈曲过紧TKA相比,增加胫骨后倾角后,在屈曲30°、60°、90°和120°时前后松弛度、内外翻松弛度和旋转松弛度均明显增大（P〈0．05）。PCL部分松解与屈曲过紧TKA相比,在屈曲30°、60°、90°和120°时前后松弛度明显增加（P〈0．05）;旋转松弛度在屈曲30°、60°、90°时明显增加（P〈0．05）。与PCL部分松解相比,增加胫骨后倾角的内外翻松弛度在屈曲30°、60°、90°时明显较大（P〈0．05）;旋转松弛度在屈曲0°、30°、60°和90°时明显较大（P〈0．05）。屈曲过紧TKA的最大屈曲度（120．4°）与正常TKA（130．3°）及增加胫骨后倾角（131．1°）相比明显较小（P〈0．05）。增加后倾角与PCL部分松解（124．0°）相比,最大屈曲度较大,但差异无统计学意义（P=0．0816）。结论屈曲间隙过紧TKA术后膝关节的前后松弛度、内外翻松弛度、旋转松弛度和最大屈曲度均减小;增加胫骨平台后倾角后,前后松弛度、内外翻松弛度、旋转松弛度和最大屈曲度均明显增大;PCL部分松解仅能明显增大前后松弛度。因此对于TKA术中屈曲紧张的膝关节,增加胫骨平台后倾角比PCL部分松解能更好地改善膝关节的运动学。     

Effect of soft tissue tension on measurements of coronal laxity in mobile-bearing total knee arthroplasty

Background The purpose of this study was to determine the effect of intraoperative coronal laxity in total knee arthroplasty on the postoperative condition. Methods We conducted stress arthrometric studies using a Telos arthrometer on 40 knees in 36 patients. Both posterior cruciate ligament-retaining (PCLR) prostheses and posterior cruciate-sacrificing (PCLS) prostheses were placed in 20 knees respectively. All of the TKA procedures were judged clinically successful (Hospital for Special Surgery scores: PCLR 92 ± 3 points, PCLS 91 ± 4 points). Laxities were measured under spinal anesthesia (immediately postoperatively) and 6 months postoperatively. Results PCLR prostheses had an average of 2.9° ± 1.8° and 3.0° ± 1.2° in abduction and 4.4° ± 2.8° and 3.6° ± 1.5° in adduction under anesthesia and the postoperative condition. PCLS prostheses had average laxities of 3.8° ± 1.4° and 3.5° ± 0.9° in abduction and 4.6° ± 3.8° and 4.0° ± 1.7° in adduction. There were no significant differences between them. Conclusions The findings suggest that surgeons should emphasize the achievement of suitable laxity under anesthesia to ensure the success of total knee arthroplasty.     

膝关节后交叉韧带保留型假体置换术15年远期疗效研究

目的 针对后交叉韧带(posterior cruciate ligament,PCL)保留型膝关节假体置换术进行15年以上临床随访研究,分析其临床疗效及失败原因.方法 对Medico-Chirurgical du Cedre中心1990年9月至1992年3月行PCL保留型全膝关节假体初次置换术获得随访的153例(178膝)患者的临床资料进行回顾性研究.对其采用术后X线测量结合随访时国际膝关节协会临床评分评估手术疗效,X线测量包括髋膝踝角(HKA)平均值、HKA绝对偏差、α角、β角、髌骨指数(AP/AT)、胫骨后倾角(PTA)等.以翻修率作为假体生存率最终评定标准.结果 153例患者随访时31例(49膝)死亡,4例(4膝)失访,获访118例(125膝).翻修11膝,15年以上假体生存率93.7%.翻修11膝原因分别为:9膝为假体界面无菌性松动(其中7膝伴严重骨溶解,2膝为胫骨假体周围透亮线伴疼痛),1膝反曲畸形,1膝内侧胫骨平台塌陷.术后随访时膝关节协会评分达173分,优良率95.9%.对比翻修患者与未翻修患者临床资料:对侧未手术膝关节内外翻角、术前正位X线片β角、两组手术前后膝关节协会评分差异均有统计学意义(P＜0.05).结论 PCL保留型假体可以较好地恢复膝关节生物力学特性,15年以上生存率优良.仅个别病例失败与PCL失效有关,聚乙烯衬垫后部过度磨损和髌股关节并发症少见.未手术侧膝关节畸形程度和术侧膝关节胫骨侧内翻畸形程度可能是影响假体翻修率的重要因素.     

Knee Kinematics in Anterior Cruciate Ligament-Substituting Arthroplasty With or Without the Posterior Cruciate Ligament

Few studies have compared functional kinematics in knees using identical prostheses with or without the posterior cruciate ligament (PCL). This study contrasted in vivo knee kinematics with an anterior cruciate ligament-substituting arthroplasty with and without PCL retention. We hypothesized that knees without PCLs would exhibit less femoral posterior translation, and consequently less maximum knee flexion. Fifty-six knees were studied using dynamic radiography at least one year post-surgery, with twenty-seven knees retaining the PCL and twenty-nine knees having the PCL sacrificed. Consistent with our hypothesis, PCL-sacrificing knees showed more anterior femoral condylar positions. Contrary to our hypothesis, PCL-sacrificing knees demonstrated greater knee flexion during kneeling (122° versus 115°). Contracted PCLs in severely deformed knees likely were the cause of limited flexion in some retaining knees.     

股骨单隧道内分叉双束纤维重建后交叉韧带的实验研究

目的在人膝关节标本上行股骨单隧道分叉双束纤维重建后交叉韧带(posterior cruciate ligament,PCL),探讨其术式的优缺点。方法应用力学试验机对14侧捐赠新鲜冷冻人膝关节标本进行生物力学测试,男12侧,女2侧;年龄20～31岁。标本股骨段长20cm,胫骨段长20cm。首先测量PCL完整时胫骨后移距离和交叉韧带的应变(完整组,n=14);然后切断PCL(切断组,n=14),测量胫骨受力时的后移距离后,再将标本随机分为两组:单束重建组(n=7)和分叉双束重建组(n=7),分别测量屈膝0、30、60、90和120°5个角度时胫骨后移距离和移植韧带的应变。结果胫骨受到100N后向力量,完整组在不同屈膝角度下,胫骨向后移位1.97±0.29～2.60±0.23mm,前外束和后内束纤维交替紧张松弛。切断组膝关节明显松弛,胫骨向后移位达11.27±1.06～14.94±0.67mm,与完整组比较差异有统计学意义(P<0.05);单束纤维重建组,在不同屈膝角度下胫骨向后移位1.99±0.19～2.72±0.38mm,移植韧带持续紧张。双束纤维重建组在不同屈膝角度下胫骨向后移位2.27±0.32～3.05±0.44mm,移植的双束纤维交替紧张,协同作用。组内比较:双束重建组在不同屈膝角度时胫骨向后位移差异无统计学意义(P>0.05),而单束重建组在屈膝90°时与屈膝30、60和120°时相比,胫骨后移增大,差异有统计学意义(P<0.05)。结论股骨单隧道内分叉双束纤维重建PCL术在各屈膝角度均能有效防止胫骨后移,股骨单隧道单束重建术屈膝90°时后移较其他角度时增大。分叉双束重建PCL的两束纤维束交替紧张,生物力学特征更接近于正常PCL。     

Clinical Outcome of Total Knee Arthroplasty With Medial Pivot Prosthesis : A Comparative Study Between the Cruciate Retaining and Sacrificing

The purpose of this study is to evaluate results after total knee arthroplasty using a medial pivot prosthesis with the posterior cruciate ligament (PCL)-retaining and PCL-sacrificing techniques. The PCL was retained in 67 knees and sacrificed in 70 knees. The mean Knee Society knee score increased from 59.6 before surgery to 91.5 at the last follow-up, and the mean function score increased from 53.6 to 85.4. The mean preoperative femorotibial angle was varus 4.1°, which corrected to valgus 5.8° after surgery. The increased knee and function score did not vary significantly between the cruciate-retaining and cruciate-sacrificing groups (P > .108), nor did the mean preoperative and postoperative femorotibial angle (P > .140). The clinical results of total knee arthroplasty with a medial pivot prosthesis were satisfactory, whether the PCL was retained or sacrificed.     

Knee stability in posterior cruciate ligament retaining total knee arthroplasty

Anteroposterior knee laxity was evaluated in 14 patients (19 knees) who had posterior cruciate ligament retaining total knee arthroplasty using the Miller Galante I prosthesis. The followup ranged from 87 to 118 months (average, 105.9 months), and the measurements were done using the KT-2000 arthrometer. The mean anteroposterior displacement with the knees with Miller Galante I prostheses was 10.1 mm at 30 degrees flexion and 8.1 mm at 75 degrees flexion. In the 15 knees with Miller Galante I prostheses with flexion greater than 90 degrees, seven had less stability at 75 degrees than at 30 degrees flexion. These knees were considered to have a nonfunctional posterior cruciate ligament, and they had a worse Knee Society score (81.1) than did the other eight knees with Miller Galante I prostheses (89.9). There were four knees in which the flexion was less than 90 degrees. In this study, approximately half of the knees with posterior cruciate ligament retaining total knee arthroplasty did not have good anteroposterior stability in flexion an average of 9 years after surgery.     

Changes in anteroposterior stability following total knee arthroplasty

This study evaluated the changes in anteroposterior stability at flexion and extension following posterior cruciate ligament (PCL)-retaining and PCL-substituting total knee arthroplasty (TKA), in comparison with normal knees. Altogether, 29 knees of 24 patients underwent either PCL-retaining (n = 19) or PCL-substituting (n = 10) TKA. Anteroposterior displacement was measured with a KT-2000 arthrometer preoperatively, 1 month after surgery, and again an average of 3 years after surgery. Anteroposterior stability at flexion and extension did not change following PCL-retaining TKA and was not significantly different from that of normal subjects, whereas anteroposterior stability increased following PCL-substituting TKA and was significantly greater than that of normal subjects an average of 3 years after surgery.     

Inlay技术在后十字韧带和后外复合体损伤中的应用

目的 介绍inlay技术的手术适应证及早期临床疗效.方法 完成后十字韧带inlay重建及后外复合体重建手术24例,男18例,女6例;年龄19～52岁,平均33.8岁.在后十字韧带胫骨解剖附丽区制备20 mm×10 mm×8 mm骨槽,将移植物带骨块一端嵌入骨槽,用两枚空心螺钉垫片固定.关节镜监视下采用自外向内的方法制备后十字韧带股骨侧隧道,植入移植物的另一端,采用挤压螺钉固定.术前、后均行IKDC主、客观评分、查体、KT-1000测量、应力x线片测量.结果 24例患者获得随访,随访时间12～33个月,平均26.9个月.术前IKDC评分为C或D;后抽屉试验均＞2+,其中3+及4+者占83%(20/24),平均3+;KT-1000平均13.7 mm(10～29 mm);应力X线片测量平均13.9 mm(10～29 mm).术后IKDC评分为:A,5膝;B,18膝;D,1膝;后抽屉试验结果为:0(正常)5例,1+11例,2+7例,3+以上1例,平均1+,较术前平均改善2+;KT-1000平均4.8 mm(-4～18.2 mm),较术前平均改善8.9 mm;应力X线片测量平均5.3 mm(-1.7～18.2 mm),较术前平均改善8.6mm.1例失败.膝关节活动度屈膝受限平均7.5°(0°～25°).无伸膝受限的病例.结论 Inlay技术可用于重建损伤的后十字韧带和后外复合体.     

The posterior cruciate ligament in total knee arthroplasty

The purpose of this study was to answer 2 questions: Does the posterior cruciate ligament (PCL) produce femoral rollback in a single-design, cruciate-sparing total knee arthroplasty (TKA)? Does the PCL prevent posterior tibial displacement when it is retained after a single-design, cruciate-sparing TKA? Knee kinematics and limits of motion were measured with the knees in the following states: (1) intact knee, (2) anterior cruciate-deficient knee, (3) PCL-retaining total knee of a single design (TKA), (4) PCL-retaining TKA with PCL cut, and (5) PCL-substituting TKA. Femoral rollback was then calculated from the above data. The results showed that the PCL was able to prevent posterior translation and maintain femoral rollback when it was preserved during TKA. Therefore, the PCL can be functional after TKA, in a single-design, cruciate-sparing TKA. When the PCL was cut, significant changes in knee kinematics were observed.     

In vivo laxity of low contact stress mobile-bearing prostheses

A stress arthrometric study was done on 60 knees in 54 patients with total knee arthroplasties using a Telos arthrometer, to determine anteroposterior and abduction and adduction laxity and to evaluate the relationship between laxity and retention of the posterior cruciate ligament using low contact stress mobile-bearing prostheses. Thirty knees had posterior cruciate ligament-retaining and 30 had posterior cruciate ligament-sacrificing prostheses. The selected patients had successful knee arthroplasty 6 months previously. Anteroposterior displacement was measured at 30 degree and 90 degree flexion; there were no statistically significant differences between the posterior cruciate ligament-retaining (10.5 mm at 30 degree, 9.3 mm at 90 degree) and posterior cuciate ligament-sacrificing (9.8 mm at 30 degree, 9.7 mm at 90 degree) groups. Abduction and adduction were between 0 degree and 20 degree flexion, there were no significant differences between the two groups. Because all the patients in this study had good clinical results, approximately 10 mm anteroposterior displacement and 4 degree laxity in the coronal direction are considered favorable in low contact stress mobile-bearing prostheses of both designs.     

A radiographic analysis of anterior-posterior translation in total knee arthroplasty

We performed radiological analyses to examine the relationship between the knee flexion angle and the anteroposterior translation movement relative to the prosthetic components (NexGen type) after total knee arthroplasty (TKA). Cruciate-retaining (CR) type TKA was performed in 12 knees with osteoarthritis (OA) and 9 knees with rheumatoid arthritis (RA) in which no posterior cruciate ligament (PCL) tear was present. Posterior-stabilized (PS) type TKA was performed in 7 OA knees and 7 RA knees in which the PCL was defective or resected. The measurements were performed according to the methods of Watanabe. The contact point ratio (percentage) was calculated by dividing the distance to the contact point (CP; the closest point of contact between the femoral and tibial components) by the antero-posterior length of the tibial component. After TKA, the CP at full extension was positioned more posteriorly than in the normal knee both under weight-bearing and non-weight-bearing conditions. Except for the RA knees in the PS group, the CP translated anteriorly in the early phase of flexion and then posteriorly. Under weight-bearing conditions, the posterior translation occurred earlier and was smaller in magnitude. For RA knees in the PS group, the CP moved gently posteriorly right from the beginning. Received: May 16, 2000 / Accepted: April 10, 2001     

Arthroscopic single- versus double-bundle posterior cruciate ligament reconstructions using hamstring autograft

This prospective study compared the clinical results of single- and double-bundle posterior cruciate ligament (PCL) reconstruction with a minimum follow-up of 2 years. There were 35 patients including 19 single- and 16 double-bundle posterior cruciate ligament reconstructions using hamstring autograft. The average age was 29.4±13.6 years versus 28.2±10.4 years; and the average follow-up was 41.0±13.1 months versus 28.2±4.2 months for single- and double-bundle reconstruction, respectively. The indication for surgery was functional disability of the knee due to pain and instability as the result of high-energy PCL injury. The evaluation parameters included functional assessment, ligament laxity, functional score and radiographs of the knee. The results showed no significant difference in functional assessment, ligament laxity, functional score and radiographic changes of the knee between the two techniques. The rate of overall satisfaction with the operation was comparable from patient and surgeon perspectives. Contrary to many recent reports, the results of this study showed that single- and double-bundle PCL reconstruction using hamstring autograft produced comparable clinical results in medium-term follow-up. The difference between single- and double-bundle PCL reconstruction, if any, can be concluded only with long-term results and larger number of patients.     

自体骨-髌腱(中1/3)-骨重建后交叉韧带的中长期临床观察研究

目的 观察应用自体骨-髌腱(中1/3)-骨进行后交叉韧带关节镜下单束重建的中远期临床效果,探讨后交叉韧带重建的手术原则及影响因素.方法 1998年5月至2004年7月共对29例患者行自体骨-髌腱(中1/3)-骨后交叉韧带关节镜下单束重建,术后22例获得5～10年随访(平均7.1年).评价指标:膝关节功能评分、KT2000、Biodex肌力测试及膝关节X线片评价.结果 22例患者术后平均IKDC、Lysholm及Tegner评分分别为89.4±8.1、94.5±9.2与6.9±2.6,较术前均有明显提高(P<0.01).22例患者术后KT2000结果平均为(4.9±1.1)mm(屈膝90°位)与(4.3±1.2)mm(屈膝30°位).术后屈膝30°KT2000测量结果≥6 mm者6例(A组),<6 mm者16例(B组),两组三种功能结果差异均具有统计学意义(P<0.01),两组术前病程平均值分别为(17.6±3.9)个月与(2.9±2.1)个月,差异具有统计学意义(P<0.01).术后Biodex结果为:患侧膝关节伸膝的峰力矩为健侧的(90±22)%(60°/s)与(87±19)%(120°/s),屈膝峰力矩为健侧的(93±16)%(60°/s)与(92±20)%(120°/s),屈膝峰力矩大于相同条件下伸膝峰力矩(P<0.01).X线片显示:8例患者(36.4%)出现轻度退变,2例(9.1%)出现中度退变,12例患者(54.5%)X线片未见明显退变.关节退变患者与关节未退变患者的术前病程平均值分别为(16.6±2.7)个月与(3.3±1.7)个月,差异具有统计学意义(P<0.01).结论 应用自体骨-髌腱(中1/3)-骨进行后交叉韧带关节镜下单束重建的中、远期临床效果良好,Ⅲ度PCL断裂应该及早手术.     

后十字韧带单束重建联合小切口切开腘腓韧带重建治疗严重膝关节不稳定

目的 评估后十字韧带(posterior cmciate ligament,PCL)单束重建联合小切口切开腘腓韧带(popliteofibular ligament,PFL)重建治疗严重的膝关节后向和后外旋转不稳定的临床结果.方法 自2003年7月至2007年4月,共有28例连续的患者接受关节镜下PCL单束重建联合小切口切开PFL重建手术.人选条件:所有患者均为严重的膝关节不稳定,后抽屉试验为3~+或以上,胫骨后移程度与健侧相比≥12mm,胫骨外旋程度大于健侧10°以上,同时不合并外侧副韧带的损伤.入选的患者接受关节镜下单束PCL重建,使用异体跟腱作为移植物.在膝关节外侧通过两个小切口切开,使用异体胫前肌腱重建PFL.股骨侧切口位于股骨外上髁,长度为2cm;腓骨侧切口位于腓骨头,长度为3 cm.结果 术后平均随访时间为39.7个月.使用膝关节应力像评估后向稳定性,胫骨后移程度(患侧与健侧的差值)由术前(17.7±4.5)mm减小为术后(4.5±3.9)mm,胫骨外旋程度(患侧与健侧的差值)由术前16.0°±4.7°减小为术后-2.8°±6.4°,术前与术后的差异有统计学意义.IKDC评分:术前28例均为D级,术后A级为10例,B级9例,C级8例和1例D级.结论 关节镜下PCL单束重建联合使用小切口切开PFL重建能够有效地改善膝关节后向和后外旋转不稳定.     

Range of motion during the perioperative period in total knee arthroplasty

INTRODUCTION: This study focused on the change in the range of motion (ROM) during the perioperative period, i.e., the preoperative and intraoperative ROM, and that on discharge, and compared the difference between posterior cruciate ligament-retaining (PCLR) and -sacrificing (PCLS) prostheses. MATERIALS AND METHODS: In this prospectively randomized study, we compared the changes in the ROM in PCLR (n = 50) and PCLS (n = 50) total knee arthroplasties. RESULTS: The mean flexion in PCLR prostheses was 130.0 degrees preoperatively, 120.0 degrees intraoperatively, and 105.0 degrees at discharge, and 125.0 degrees , 120.0 degrees , and 100.0 degrees , respectively, in PCLS. The designs did not differ statistically in each period (P > 0.05). Both designs showed significant correlations between the preoperative and intraoperative ROM, and between the preoperative and discharge ROM. Only the PCLS showed a significant correlation between the intraoperative and discharge ROM, and a significant difference was observed in correlation of rank coefficient between the two prostheses (P < 0.001). CONCLUSIONS: The PCLS design has an advantage in rehabilitation planning because of the predictable changes in the ROM during the perioperative period, although the acquired average ROM at discharge did not differ statistically.     

TC-Dynamic后稳定型人工全膝关节系统术后近期疗效分析

目的探讨应用TC-Dynamic后稳定型人工全膝关节系统行全膝关节置换术(totalknee arthroplasty,TKA)的近期临床效果,评价其临床应用的可行性、安全性和有效性。方法2003年9月～2004年3月,应用TC-Dynamic人工全膝关节系统行TKA10例12膝(TC-Dynamic组),术前膝关节KSS(kneesocietyscore)评分为16.08±11.58分,功能评分为13.75±19.79分,膝关节活动度(rangeofmotion,ROM)为75.00±26.46°。同期使用Scorpio假体行TKA30例50膝(Scorpio组),术前膝关节KSS评分为19.48±9.67分,功能评分为3.16±19.82分,膝关节ROM为80.80±22.82°。比较两组患者术后疼痛缓解情况、KSS评分和功能评分改善情况,以及膝关节ROM的提高程度。结果所有患者术后获随访40～210d,平均130d。TC-Dynamic组术后KSS评分为88.83±4.04分,较术前改善72.75±14.47分,功能评分为79.17±5.15分,较术前改善65.42±19.47分;ROM为107.92±11.57°,较术前提高32.92±32.22°。Scorpio组术后KSS评分为85.68±7.36分,较术前改善66.20±10.44分,功能评分为71.40±12.70分,较术前改善68.24±25.35分;ROM为109.20±11.13°,较术前提高28.40±26.41°。术后各指标组间比较差异均无统计学意义(P>0.01)。两组患者术后X线片均示下肢力线良好,假体位置满意,无透亮线及任何松动迹象。结论TC-Dynamic后稳定型膝关节假体设计合理,术后近期效果良好;但远期疗效仍需大样本长期随访观察。TKA中正确的下肢力线、合理截骨和软组织平衡及屈曲伸直间隙平衡等,是获得良好临床效果和保证假体长期存活的关键。     

关节镜下缝线加强治疗后交叉韧带损伤

目的 介绍关节镜下缝线加强固定治疗后交叉韧带(PCL)损伤的方法 ,研究其临床效果.方法 2005年10月至2006年6月,对13例单纯PCL损伤患者,在关节镜下采用缝线固定维持胫骨中立位,增加PCL的紧张度.采用IKDC和Lysholm膝关节功能评分表对患膝功能进行评估,通过KT-1000检查比较膝关节的后向松弛度. 结果 术后无伸膝受限,屈膝活动度120°～140°,平均128°.术后随访12～18个月(平均14.5个月),最后随访时IKDC评分:A 6例,B 7例;IKDC膝关节主观评分从术前的(67.4±3.3)分提高到随访结束时的(92.5±4.5)分,差异有统计学意义(t=9.837,P<0.01).屈膝90°位KT-1000检查,双侧胫骨结节后坠差异从术前的(8.1±1.7)mm减少到最后随访时的(2.0±1.3)mm,差异有统计学意义(t=12.230,P<0.01).陈旧性损伤患者术前Lysholm膝关节功能评分为(87.5±3.1)分,最后随访时为(95.8±3.5)分,差异有统计学意义(t=5.376,P<0.01).12例患者恢复了原来的运动水平,1例较损伤前稍有降低. 结论 在关节镜下采用缝线加强固定治疗急性PCL中远部损伤,能取得良好效果;治疗陈旧性PCL部分损伤,能够获得满意的结果.