胫骨后倾截骨对后十字韧带保留型全膝关节置换术疗效的影响

目的 探讨胫骨后倾截骨对后十字韧带保留型全膝关节置换术后临床疗效的影响.方法 2008年1月至2009年3月应用胫骨后倾5°截骨(后倾组)进行后十字韧带保留型全膝关节置换治疗骨关节炎患者27例(27膝),男7例7膝,女20例20膝;平均年龄69.5岁.同期应用胫骨后倾0°截骨(非后倾组)57例57膝,男15例15膝,女42例42膝;平均年龄67.4岁.两组患者术前一般资料、膝关节最大伸直角度、最大屈曲角度和美国膝关节协会评分(knee society score,KSS评分)差异均无统计学意义.比较术后两组胫骨后倾角、关节最大伸直角度、最大屈曲角度和KSS评分的差异.结果 所有患者均获随访12～24个月,平均(15.7±4.3)个月.未发生腓总神经损伤、伤口感染、假体脱位、假体松动等并发症.后倾组术后胫骨后倾角5.7°±2.1°,非后倾组0.9°±0.6°.后倾组术后关节最大伸直角度0.8°±0.3°,非后倾组1.2°±0.4°,差异无统计学意义.后倾组术后关节最大屈曲角度115.7°±4.8°,非后倾组101.1°±5.6°,差异有统计学意义.后倾组术后KSS评分(87.6±5.9)分,非后倾组(83.3±7.2)分,差异无统计学意义.结论 在后十字韧带保留型全膝关节置换术中胫骨后倾截骨可以增加术后关节最大屈曲角度,但对最大伸直角度和KSS评分无明显影响.

Investigation of preliminary clinical outcome following PCL-retaining total knee arthroplasty with posterior tibial slope

Objective To investigate the preliminary clinical outcome following PCL-retaining total knee arthroplasty (TKA) with 0°or 5°posterior tibial slope. Methods From Jan 2008 to Mar 2009, 84 patients (84 knees) with osteoarthritis (OA) underwent primary PCL-retaining TKA operations by the same surgical team. Among them, 27 patients (7 males, 20 females, with the average age of 69.5 years) underwent TKA using a cutting block and intramedullary cutting guide designed to impart a 5° posterior tibial slope (group A); 57 patients (15 males, 42 females, with the average age of 67.4 years) underwent TKA using a cutting block and intramedullary cutting guide designed to impart a 5°posterior tibial slope (group B). The preoperative demographic data and functional data had no statistical differences. The postoperative tibial posterior angle, maximum extension, maximum flexion and Knee Society Score (KSS) were compared between the two groups. Results All patients were followed up 12～24 months with an average of 15.7 months. No paralysis, wound infection, prosthesis dislocation and loosening were found. The postoperative tibial posterior angle was 5.7°±2.1° in group A and 0.9°±0.6°in group B (P＜ 0.05). The postoperative maximum extension was 0.8°±0.3°in group A and 1.2°±0.4°in group B (P ＞0.05). The postoperative maximum flexion was 115.7°±4.8°in group A and 101.1°±5.6°in group B (P＜ 0.05). The postoperative KSS was 87.6±5.9 in group A and 83.3±7.2 in group B (P ＞0.05). Conclusion Increasing tibial posterior slope improved the postoperative maximum flexion, but not the maximum extension and KSS, in PCL-retaining TKA.