• 作者： 江清泉; 劉?珊; 溫振源; 劉堂桂
• 作者服務機構： 台大醫學骨科部; 台大醫學院解剖學科
• 中文摘要： 保留十字韌帶之人工膝關節設計是目前台灣骨科使用最廣泛的人工關節，這類人工膝關節發展迄今不過十年，尚有許多待改進的地方。文獻上已有人注意到手術後關節面上升會影響膝關節之活動度，我們則發現保留的後十宇韌帶被拉長，也可能是影響活動度的主因，因此設計本研究。 本研究係探用直接測量在膝關節活動過程中，後十字韌帶(PCL)的長度變化；第一部份使用五付乾燥人體股骨和脛骨，利用細鋼絲(#30)一端固定於PCL在股骨上之起源端(Origin)，另一端則通過位於脛骨上的終止端(Insertion)然後連接於長度測量器，當膝關節從0度屈曲到90度，即可記錄PCL的長度變化。第二部份取PCA, M/G, Osteonics和Tri-con人工膝關節各一付按第一部份之方法，記錄PCL的長度變化。第三部份則使用五付泡浸福馬林之屍體膝關節，按第一部份之方法，先測量PCL之長度變化，再將Tricon人工膝關節依正規之手術式置入，重新測量PCL之長度變化。 正常的膝關節屈曲0°至90°，後十字韌帶伸長0.08公分。置換全人工關節(Tricon)後，測得之PCL伸長量為0.17公分。三個不同的起源端（前、中、後）在乾燥的膝關節標本測量沒有roll-back之情況下，膝關節屈曲0°至90° PCL之伸長量分別為1.1、0.5和0.1公分；而現成四種人工膝關節（M/G, Tricon, PCA和Osteonics）在同樣情況下測得PCL之伸長均在1.9公分以上，而且以M/G之3.1公分最大，此與人工膝關節股骨矢狀面之曲率半徑有關。 保留後十字韌帶之人工膝關節置入體內，當膝關節彎曲時，roll-back必然發生，以克服韌帶被拉緊之問題。
• 英文摘要： Restriction of knee motion after total knee replacement was noted to be associated with lengtheningof the posterior cruciate ligament during flexion of the knee which was replaced with a cruciate retainingknee prosthesis. The purpose of this study was to measure the excursion length of the PCL in the normalknee in four different cruciate-retaining knee prostheses, and in five cadaveric knees which were replacedwith the Tricon prosthesis. For every knee, the tibial part was fixed on a stand and the femoral part was allowed to do flexion-extension motion upon the tibial plateau. The angle of the motion was monitored by the self-readoutgoniometer. A thin wire cord was attached to the proposed origin site of the PCL on the femur. Thewire cord was passed through a tiny hook which was attached to the proposed insertion site of the PCL onthe tibia and connected to a dial gauge. The excursion length of the PCL during 90° flexion was measured.The same measurement was repeated five times in each cadaver knee and prosthetic knee studied, and in fiveknee specimens which were replaced with the Tricon prosthesis. The excursion length of the PCL during 0° to 90° of flexion in five cadaver knees averaged 0.08cmof lengthening. Three different origin sites of the ligament were designated to represent the anterior, middleand posterior part of the ligament. In a controlled knee flexion without a roll-back component, the ex-cursion length of the PCL in the dried cadaver knee specimen was found to have lengthened 1.1, 0.5, 0.1cm respectively for the above mentioned three parts of the PCL. The excursion lengths of the four typesof the knee prosthesis were more than 1.9 cm in all the measurements despite the various locations of theorigin. The M/G prosthesis produced the greatest excursion (3.1 cm) in the anterior portion of the PCL.The radii of the curvature of the femoral condyle in the sagittal plane of the femoral prostheses were thecause of the lengthening effect on the PCL. The excursion length of the PCL during 0° to 90° of flexionin five cadaver knees that were replaced with the Tricon prosthesis averaged 0.17 cm, which was muchsmaller than the excursion length (2.3 cm) of the same knee prosthesis during controlled knee flexion withouta roll-back component. Roll-back motion did occur in this measurement and was responsible for the decreaseof the excursion length in the PCL.
• 中文關鍵字： posterior cruciate ligament; excursion length; total knee replacement; knee
• 英文關鍵字： --