全膝关节置换术中是否需要保留后交叉韧带?

全膝关节置换术可有效缓解终末期膝骨关节疾病患者的关节病痛，重塑关节完整性。全膝关节置换术中是否需要保留后交叉韧带，国内外学者一直有所争论。近年来，保留后交叉韧带和不保留后交叉韧带的膝关节假体（CR假体和PS假体）在临床上均广泛应用。一般认为，采用CR假体或PS假体在术后满意度、膝关节屈伸活动度、假体存留率及主要临床表现等方面没有显著差异。CR假体更加符合人体正常生理功能及其生物力学性能，患者术后上下楼梯时的步态更加均衡，本体感觉也更好，但关节在屈曲时，股骨对胫骨产生反常后移，可导致反常运动；而PS假体能够纠正膝关节严重畸形，更好地平衡膝关节屈伸间隙，但存在发生髌骨弹响综合征的风险。建议同等条件下，对于年龄相对较小的患者优先选择CR假体，而对于年龄较大的患者则优先考虑PS假体。本文结合后交叉韧带的作用及其处理技术，分析CR假体和PS假体应用于膝骨关节炎患者的利弊，供临床工作者参考。

Choice of total knee arthroplasty: posterior cruciate ligament preserved or not

Total knee arthroplasty is an effective method for the treatment of end-stage knee osteoarthrosis, which can effectively relieve joint pain and reconstruct the integrity of the joint. Whether the posterior cruciate ligament should be preserved during surgery or not, which is still in dispute. In recent years, posterior cruciate-retaining and substituting total knee prostheses are both applied in clinical practice. Both domestic and international studies have shown that there are no significant difference in patient satisfaction, knee flexion, survival rate of the prosthesis and the main clinical manifestations between two prostheses. However, posterior cruciate-retaining total knee prosthesis is more consistent with the normal physiology and biomechanics of the human body. The gait is more balanced and proprioceptive when walking up and down the stairs, but when the joints are buckling, the femur is abnormal to move back to the tibia, resulting in abnormal motion. While posterior cruciate-substituting total knee prosthesis can correct severe deformity of the knee, and keep better balance between flexion and extension of the knee joint, but there is a potential complication of patellar clunk syndrome. Therefore, under the same conditions, the younger patients may prefer to chose posterior cruciate-retaining total knee prosthesis, while elder patients may prefer to chose posterior cruciate-substituting total knee prosthesis. This paper reviews the function of posterior cruciate ligament, as well as the advantages and disadvantages of two prostheses, so as to provide some references for clinic.