松解后交叉韧带是否会影响全膝关节置换术后效果
Does Recession of the Posterior Cruciate Ligament Influence Outcome in Total Knee Arthroplasty?
Background: For a PCL-retaining (posterior cruciate ligament) total knee arthroplasty (TKA) to function suitably, proper soft tissue balancing, including PCL recession, is required. Yet, when the recession of the PCL is needed, there is still a debate as to whether a cruciate-retaining (CR) TKA should be converted to a posterior-stabilized TKA due to the concern of instability and poorer clinical outcomes. The purpose of this study is to determine whether recession of the PCL adversely affects clinical outcomes in patients who undergo CR TKA.
Methods: CR TKAs of the same design performed by the senior author (J.M.) were identified between December 2006 and July 2015. Clinical outcome measurements were collected and included the Western Ontario and McMaster Universities Osteoarthritis Index score, the Knee Society Clinical Rating System, Short Form-12 Physical Composite Score/Mental Health Composite Score, and revision rates.
Results: There were no significant differences in clinical outcome when the PCL was retained, partially recessed, or completely released during PCL-retaining TKA (Western Ontario and McMaster Universities Osteoarthritis Index: P = .54, Knee Society Clinical Rating System: P = .42, Short Form-12 Mental Health Composite Score: P = .89, Short Form-12 Physical Composite Score: P = .527).
Conclusion: This study presents evidence of similar clinical outcomes when the PCL is retained or released during PCL-retaining TKA, provided attention is paid to appropriate soft tissue balancing. CR TKA undergoing partial or complete release of the PCL should not routinely be converted to a posterior-stabilized knee design.
松解后交叉韧带是否会影响全膝关节置换术后效果
译者：张轶超
背景：对于后交叉韧带（PCL）保留型假体的全膝置换手术（TKA），要想达到良好的功能可能需要通过松解后交叉韧带来达到软组织平衡。但是一直有意见认为当松解了PCL后，考虑到关节稳定性和临床效果是否就应该将后交叉保留型（CR）假体换成后稳定型（PS）假体。本文的目的就是确定松解PCL会不会影响CR假体TKA的效果。
方法：选取从2006年12月到2015年7月间由本文作者中最年长的医生(J.M.)完成的CR-TKA患者。通过西安大略和麦克马斯特大学骨关节炎指数评分（WOMAC）、膝关节协会临床等级系统（KSS）、简易生活质量问卷（SF-12）物理/精神混合评分及翻修率来评估临床效果。
结果：对行CR-TKA患者的观察显示，无论是未对PCL松解的还是部分松解的或完全切断的病例间各项评分均无明显差异（WOMAC评分：P=0.54；KSS评分：P=0.42；SF-12精神混合评分：P=0.89；SF-12物理混合评分：P=0.527）。
结论：本研究表明当做CR-TKA时，无论是完好保留PCL还是松解PCL其临床效果相近。医生更应该注重的是软组织平衡。做CR假体时，如果部分松解或完全切断了PCL也不必更换成PS假体。
文献出处：Dion CB, Howard JL, Lanting BA, McAuley JP. Does Recession of the Posterior Cruciate Ligament Influence Outcome in Total Knee Arthroplasty? J Arthroplasty. 2019 Oct;34(10):2383-2387. doi: 10.1016/j.arth.2019.05.052. Epub 2019 Jun 5. PMID: 31326243.