CAJ | 학술논문

目的：比较全膝关节置换术(total knee arthroplasty，TKA)中切除后交叉韧带和松解内侧副韧带浅层对膝关节间隙的影响。方法2013年4月-2014年5月因膝关节重度骨关节炎致膝内翻畸形在我院行单膝关节置换患者83例，随机分为A组和B组。术中进行软组织平衡过程中，A组顺序使用切除后交叉韧带和松解内侧副韧带浅层两种方法，B组仅使用松解内侧副韧带浅层一种方法。使用关节间隙测量器分别在上述处理前后测量关节在伸膝(0°)和屈膝(90°)时的内、外侧间隙大小及上述处理后的张开幅度。结果 A组中，经过上述两种方法处理后伸膝间隙差异均无统计学意义，屈膝位内、外侧间隙均显著增大，其中切除后交叉韧带使屈曲内、外侧间隙分别由(15.55±0.42) mm和(19.58±0.53) mm增大至(16.88±0.53) mm和(20.60±0.63)mm (t=5.514、2.985，P=0.000、0.011)。上述方法对内、外侧间隙的影响差异无统计学意义。B组中，松解内侧副韧带浅层后，伸直和屈曲位的关节内侧间隙分别由(18.67±0.54) mm和(15.62±0.68) mm增加至(19.53±0.53) mm和(16.50±0.70) mm (t=3.180、3.705，P=0.007、0.002)，且对屈曲间隙和伸直间隙的影响无明显差异。A、B组对比，两种方法联合使用(A组)时屈膝内、外侧间隙张开幅度明显大于单独使用松解内侧副韧带浅层(B组)(t=3.949、5.687，P=0.002、0.000)，而伸膝间隙的张开幅度并无显著差异。切断后叉的基础上再行松解内侧副韧带浅层(A组)对比单独松解内侧副韧带浅层(B组)，前者的屈膝间隙张开幅度明显大于后者(t=2.880、3.088，P=0.012、0.007)，伸膝间隙的张开幅度差异不明显。结论在膝关节置换术中，切除后交叉韧带主要影响屈、伸膝间隙平衡。松解内侧副韧带浅层主要影响内、外侧间隙平衡。在术中可根据不同情况单独或联合使用上述技术。
목적：비교전슬관절치환술(total knee arthroplasty，TKA)중절제후교차인대화송해내측부인대천층대슬관절간극적영향。방법2013년4월-2014년5월인슬관절중도골관절염치슬내번기형재아원행단슬관절치환환자83례，수궤분위A조화B조。술중진행연조직평형과정중，A조순서사용절제후교차인대화송해내측부인대천층량충방법，B조부사용송해내측부인대천층일충방법。사용관절간극측량기분별재상술처리전후측량관절재신슬(0°)화굴슬(90°)시적내、외측간극대소급상술처리후적장개폭도。결과 A조중，경과상술량충방법처리후신슬간극차이균무통계학의의，굴슬위내、외측간극균현저증대，기중절제후교차인대사굴곡내、외측간극분별유(15.55±0.42) mm화(19.58±0.53) mm증대지(16.88±0.53) mm화(20.60±0.63)mm (t=5.514、2.985，P=0.000、0.011)。상술방법대내、외측간극적영향차이무통계학의의。B조중，송해내측부인대천층후，신직화굴곡위적관절내측간극분별유(18.67±0.54) mm화(15.62±0.68) mm증가지(19.53±0.53) mm화(16.50±0.70) mm (t=3.180、3.705，P=0.007、0.002)，차대굴곡간극화신직간극적영향무명현차이。A、B조대비，량충방법연합사용(A조)시굴슬내、외측간극장개폭도명현대우단독사용송해내측부인대천층(B조)(t=3.949、5.687，P=0.002、0.000)，이신슬간극적장개폭도병무현저차이。절단후차적기출상재행송해내측부인대천층(A조)대비단독송해내측부인대천층(B조)，전자적굴슬간극장개폭도명현대우후자(t=2.880、3.088，P=0.012、0.007)，신슬간극적장개폭도차이불명현。결론재슬관절치환술중，절제후교차인대주요영향굴、신슬간극평형。송해내측부인대천층주요영향내、외측간극평형。재술중가근거불동정황단독혹연합사용상술기술。
Objective To compare the effects of posterior cruciate ligament (PCL) resection vs. shallow medial collateral ligament (SMCL) releasing on joint gaps in the total knee arthroplasty (TKA) surgery.Methods From April 2013 to May 2014, there were 83 osteoarthritis patients with varus knee underwent unilateral TKA in our department. Patients were randomly divided into two groups, patients in group A underwent both PCL resection and SMCL releasing in surgery,while those in group B underwent only SMCL releasing. The joint gaps before and after surgical treatment and the related data were measured and analyzed.Results There were no statistical differences in extension gap and medial and lateralflexion gap between these two surgical treatments in group A (P>0.05), while PCL resection increased medial and lateralflexion gap significantly [(15.55±0.42) mmvs (16.88±0.53) mm,t=5.514, P=0.000; (19.58±0.53) mm vs. (20.60±0.63) mm, t=2.985,P=0.011]. In group B, SMCL releasing showed significant differences on medial gap in both extension andflexion gaps [(18.67±0.54) mmvs (19.53±0.53) mm,t=3.180,P=0.007; (15.62±0.68) mm vs (16.50±0.70) mm,t=3.705,P=0.002], but it showed no differences on lateral gap. The combination of PCL resection and SMCL releasinghad more significant influence on range of gap opening than doing SMCL releasing alone in group B (t=3.949,P=0.002;t=5.687, P=0.000), while no significant difference was found in extension gap. Doing SMCL releasing after PCL resection in group A had more significant influence than doing SMCL releasing without PCL resection in group B onflexion gap (t=2.880,P=0.012;t=3.088,P=0.007) with no significant difference in extension gap.Conclusion PCL resection has influence on the balance offlexion and extension gap during TKA surgery, while SMCL releasing mainly has influence on the balance of medial and lateral gap, which suggests that whether using the combination of these two methods or one method alone depends on different situations during surgery.