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浙江大学学报(医学版)  2018, Vol. 47 Issue (3): 313-319    DOI: 10.3785/j.issn.1008-9292.2018.06.16
综述     
全膝关节置换术中是否需要保留后交叉韧带?
王伟1,2(),刘振2(),刘军1,*(),甄平1,*(),李旭升1,宋明甲1
1. 兰州军区总医院全军骨科中心骨科研究所, 甘肃 兰州 730050
2. 宁夏医科大学研究生院, 宁夏 银川 750000
Choice of total knee arthroplasty: posterior cruciate ligament preserved or not
WANG Wei1,2(),LIU Zhen2(),LIU Jun1,*(),ZHEN Ping1,*(),LI Xusheng1,SONG Mingjia1
1. Institute of Orthopedic Research, Lanzhou General Hospital of PLA, Lanzhou 730050, China
2. Graduate School, Ningxia Medical University, Yinchuan 750000, China
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摘要:

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。

关键词: 假体和植入物后交叉韧带关节成形术, 置换, 膝综述    
Abstract:

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.

Key words: Prostheses and implants    Posterior cruciate ligament    Arthroplasty, replacement, knee    Review
收稿日期: 2018-01-06 出版日期: 2018-09-18
CLC:  R687.4  
基金资助: 国家自然科学基金(81371983);全军后勤科研计划(CWH17J009);甘肃省青年科技基金(1606RJYA300);甘肃省卫生行业科研计划(GSWSKY2018-21)
通讯作者: 刘军,甄平     E-mail: w978853599@163.com; 1192488100@qq.com;1192488100@qq.com;tutuhehtt@126.com;zhenpingok@163.com
作者简介: 王伟(1989-), 男, 硕士研究生, 主要从事创伤与骨关节外科临床研究; E-mail:w978853599@163.com; https://orcid.org/0000-0003-0774-0485|刘振(1989-), 男, 硕士研究生, 主要从事脊柱脊髓临床研究; E-mail:1192488100@qq.com; https://orcid.org/0000-0002-2101-2727
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引用本文:

王伟,刘振,刘军,甄平,李旭升,宋明甲. 全膝关节置换术中是否需要保留后交叉韧带?[J]. 浙江大学学报(医学版), 2018, 47(3): 313-319.

WANG Wei,LIU Zhen,LIU Jun,ZHEN Ping,LI Xusheng,SONG Mingjia. Choice of total knee arthroplasty: posterior cruciate ligament preserved or not. J Zhejiang Univ (Med Sci), 2018, 47(3): 313-319.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2018.06.16        http://www.zjujournals.com/med/CN/Y2018/V47/I3/313

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