膝关节伸直位僵硬的手术治疗新方法

膝关节伸直位僵硬的手术治疗新方法沈靖南，韩士英，付明，谢君鹤，李佛保对于股骨骨折造成的膝关节伸直位僵硬，传统的治疗方法是股四头肌成形术（包括切断髌旁支持带进行膝内松解）和依靠病人主动屈膝锻炼［１～６］。虽然这种术式容易松解膝关节，但在屈膝位下极难缝合...     

中西医结合治疗伸直型膝关节僵硬

作者从1996年开始采用手术松解粘连，术后早期进行无痛功能锻炼，并辅以中药熏洗治 疗伸直型膝关节僵硬11例，取得较好效果，现报告如下。 1　临床资料 　　本组共11例，男性9例，女性2例。年龄21～37岁。病程0.7～5年。病因：股骨干骨折8例， 膝关节感染后1例，胫骨平台骨折2例。关节活动度：5°～49°，平均屈膝34°。 2　治疗方法 2．1　手术方法：采用连续 硬膜外麻醉，行股四头肌成形术7例，膝关节粘连松解术3例， 股四头肌成形加膝关节松解术1例。所有病例术后膝关节屈曲度＞100°，术后放置负压引流 48 h，留置硬膜外导管，石膏托固定患肢屈膝90°。     

中西医结合治疗伸直型膝关节僵硬

作者从 1996年开始采用手术松解粘连 ,术后早期进行无痛功能锻炼 ,并辅以中药熏洗治疗伸直型膝关节僵硬 11例 ,取得较好效果 ,现报告如下。1　临床资料本组共 11例 ,男性 9例 ,女性 2例。年龄 2 1～ 37岁。病程 0 .7～ 5年。病因 :股骨干骨折 8例 ,膝关节感染后 1例 ,胫骨平台骨折 2例。关节活动度 :5°～ 49°,平均屈膝 34°。2　治疗方法2 .1　手术方法 :采用连续硬膜外麻醉 ,行股四头肌成形术 7例 ,膝关节粘连松解术 3例 ,股四头肌成形加膝关节松解术 1例。所有病例术后膝关节屈曲度 >10 0° ,术后放置负压引流48ｈ ,留置硬膜外导管 ,石…     

膝关节粘连纤维性僵直40例报告

本文报告了40例膝关节粘连纤维性僵直的治疗结果。其中手术治疗进行膝关节松解或股四头肌成形23例,麻醉下推拿12例,体疗锻炼5例,膝关节活动范围分别平均改善81.5°、54°、48°,效果良好。文内结合其诊治经验就膝关节粘连纤维性僵直的临床特征及病理改变,治疗时机与方法的选择,影响手术成败及临床效果的关键问题进行了分析讨论,同时强调了预防的重要性。     

山羊膝关节僵直动物模型的建立

目的建立与人膝关节僵直相似的动物模型。方法通过用克氏针在山羊的膝关节股骨软骨面造成损伤,在股骨干骺端前侧骨面造成粗糙面以及重叠缝合髌韧带。然后交叉克氏针联合管型石膏伸直位固定膝关节。术后8周解除制动。分别测量术后8周和术后12周时膝关节的活动范围。结果无论是在术后8周还是在解除制动的术后12周,手术膝均较对侧出现明显的伸直性膝关节僵硬。并且术后12周和术后8周比较,山羊手术膝的僵直程度没有出现明显的丢失。结论合并软骨破坏、髌韧带重叠缝合和伸直位制动可导致山羊膝关节严重和持久的伸直位僵硬。     

膝关节伸直挛缩的松解与功能康复11例

外伤性膝关节伸直挛缩主要因膝关节内骨折或出血、膝关节长期制动、滑膜切除、韧带损伤后修复重建所致 ,甚至半月板切除术后均可能发生膝关节内粘连而导致关节活动受限[1,2 ] ,膝关节僵直畸形。此类畸形较为常见。临床治疗方法较多 ,对于较重的膝关节僵硬的主要治疗方法为股四头肌松解成形术。我院骨科自 1996年 5月至 2 0 0 2年 2月在经典的股四头肌松解成形术的基础上进行了探讨性的改良 ,并结合伸膝装置的松解 ,辅以有效的康复手段治疗膝关节伸直挛缩患者 11例 ,取得了良好的疗效。现介绍如下。一、临床资料与方法1.一般资料 :本组男 7例…     

连续被动活动治疗膝关节僵直24例

膝关节僵直是膝部及其邻近结构外伤后的主要并发症之一,足以造成患者的关节功能障碍。作者于１９９３年１月～１９９５年１０月通过手术松解辅以关节仪活动行关节连续被动活动治疗膝关节僵直２４例,效果显著,现报告如下。１临床资料１１一般资料本组男１７例,女７例...     

膝关节粘连性僵直36例治疗

膝关节粘连性僵直３６例治疗武警总医院骨科孙炜,姚建祥（北京１０００３９）关键词膝关节粘连性僵直,关节松解术,ＣＰＭ,Ｊｕｄｅｔ术式股骨干骨折、股骨髁上骨折、膝关节周围手＊术、关节内外感染经常会造成膝关节粘连性僵＊直,临床上处理有时较为棘手。一般认为,...     

综合治疗膝关节骨关节病20例分析

2006年1月-2010年1月,我们采用综合治疗膝关节骨关节病20例,疗效满意。现分析报告如下。     

Acute traumatic extension deficit of the knee

The purpose of this study was to evaluate the events leading to acute traumatic extension deficit of the knee and the arthroscopic findings in these patients. A total of 78 consecutive patients treated in the Turku university hospital during the years 1994-1996 were included. The mean annual incidence of acute traumatic extension deficits of the knee in our study was 1.1 per 10 000 inhabitants. The single most common (33%) event causing the extension deficit was non-sports related twisting of the knee. Various sports related activities accounted for 42% of the extension deficits, and soccer was the most common sport in this group. In conclusion, acute traumatic extension deficit of the knee is usually a sign of serious intra-articular damage, and the most likely finding (in 82% of the patients in our study) is either a meniscal rupture, an anterior cruciate ligament (ACL) rupture, a patellar dislocation, or a combination of these. The lesions in these knees require prompt evaluation by an orthopaedic surgeon mainly because of the high number of bucket-handle and menisco-capsular insertion ruptures of the menisci, which are possibly suitable for repair.     

Effects of hamstring stretching on passive muscle stiffness vary between hip flexion and knee extension maneuvers

The purpose of this study was to examine whether the effects of hamstring stretching on the passive stiffness of each of the long head of the biceps femoris (BFl), semitendinosus (ST), and semimembranosus (SM) vary between passive knee extension and hip flexion stretching maneuvers. In 12 male subjects, before and after five sets of 90 s static stretching, passive lengthening measurements where knee or hip joint was passively rotated to the maximal range of motion (ROM) were performed. During the passive lengthening, shear modulus of each muscle was measured by ultrasound shear wave elastography. Both stretching maneuvers significantly increased maximal ROM and decreased passive torque at a given joint angle. Passive knee extension stretching maneuver significantly reduced shear modulus at a given knee joint angle in all of BFl, ST, and SM. In contrast, the stretching effect by passive hip flexion maneuver was significant only in ST and SM. The present findings indicate that the effects of hamstring stretching on individual passive muscles’ stiffness vary between passive knee extension and hip flexion stretching maneuvers. In terms of reducing the muscle stiffness of BFl, stretching of the hamstring should be performed by passive knee extension rather than hip flexion.     

Soft tissue tension in extension in total knee arthroplasty affects postoperative knee extension and stability

The purpose of this study was to assess correlation of soft tissue tension in extension with postoperative extension deficit and valgus/varus instability. Sixty-four osteoarthritic knees that underwent primary total knee arthroplasty were investigated. Soft tissue tension in extension was measured during operation with a balancer/tensor device. Extension deficit was measured, and valgus/varus laxity was assessed by stress radiographs in extension and 30°-flexion 1 year after operation. The extension deficit became larger with an increase of soft tissue tension a year after operation. (P < 0.05) The varus laxity in extension and 30°-flexion and valgus laxity in 30°-flexion became smaller with an increase of soft tissue tension (P < 0.05). Our results demonstrated that soft tissue tension during operation affects postoperative knee extension and stability. An erratum to this article can be found at     

Conditions of isokinetic knee flexion that enhance isokinetic knee extension

The results of two experiments are reported. The purpose of the initial investigation was to determine the effect of isokinetic knee flexion contraction intensity on subsequent knee extension contraction. Seven subjects performed ten isokinetic knee flexion-extension cycles at six isokinetic velocities under two antagonist contraction conditions. In the first condition, isokinetic knee flexion and extension were speed-matched, and, in the second condition, the high-speed condition, knee flexion was 7.85 rad.s-1 irrespective of knee extension velocity, which ranged from 0.52 to 7.85 rad.s-1. Significantly greater isokinetic knee extension measures were observed at low isokinetic velocities and were associated with the high-speed contraction condition. Enhancement of the knee extension contraction was in the initial work phase of the isokinetic contraction. The second experiment was conducted to determine whether the enhancement of the initial work phase could be associated, in part, with passive elastic qualities of the involved musculature. In this study the range of motion for the knee involved musculature. In this study the range of motion for the knee extension-flexion cycles was reduced from the previous 2.01 rad to 1.57 rad. Two isokinetic knee extension velocities were studied (1.57 and 7.85 rad.s-1) under five conditions: initiated from rest, initiated from isometric knee flexion MVC, and with preceding isokinetic knee flexion at 0.52, 4.19, and 7.85 rad.s-1. The hypothesis that knee extension contraction measures would not increase was supported. Based upon the results of the two experiments, it is suggested that the increases in knee extension contraction measures observed in the first experiment are at least partially mediated by the contribution to net torque by passive elastic musculotendinous elements. Further study of this phenomenon with the inclusion of electromyographic measures will allow determination of the presence and contribution of increased neural drive.     

创伤性浮膝损伤的手术治疗

目的 探讨创伤性浮膝的临床特点及手术方法.方法 对82例浮膝损伤患者的手术治疗资料进行回顾性分析.结果 82例患者获得1～6年(平均2年5个月)的随访,膝关节功能优32例,良38例,中9例,差3例,优良率为85%.结论 浮膝损伤应积极处理并发症、抢救生命.条件允许应尽早手术治疗,并根据骨折的不同类型选择相应的术式和手术顺序.术后在可能的情况下尽早开展功能锻炼.     

创伤性膝关节脱位的治疗体会

对13例膝关节脱位采用膝关节韧带修补重建术.平均随访16个月,治疗结果评定优4例,良6例,差3例.作者认为急诊复位、手术修复、重建韧带及功能锻炼可取得满意的效果.     

Location of anterior knee pain affects load tolerance in isometric single leg knee extension

ObjectivesTo investigate relationships between load tolerance of single leg isometric knee extension and athlete reported knee pain location and severity during the single leg decline squat.DesignCross-sectional study.Methods175 college basketball athletes (99 women, 76 men) in Alberta, Canada participated at the start of the 2018–19 season. Knee pain location (dichotomized into focal/diffuse pain), and severity (numerical rating scale 0–10) were collected during the single leg decline squat. Athletes completed a standardized single leg isometric knee extension to determine load tolerance (defined by pain or reduced form). A quantile regression model was used to examine the association between load tolerance and pain location adjusting for sex, years played, body mass index and team.ResultsAthletes with diffuse pain had a significantly lower median load tolerance (?0.89 kg) than athletes without pain (95% confidence interval [?1.49, ?0.29]; p = 0.003). Athletes with focal pain tolerated similar median loads (?0.42 kg) to those without pain (95% confidence interval [?1.17, 0.33]; p = 0.26). Higher knee pain severity was associated with a non-linear but consistent reduction in load tolerance (p < 0.001).ConclusionsAthlete-reported knee pain location during the single leg decline squat influenced load tolerance to isometric knee extension. Athletes with focal pain tolerated similar isometric loads to their pain free teammates. Clinicians should consider load selection of isometric knee extension for athletes with diffuse pain given their lower load tolerance. Future research should consider reporting pain location in addition to pain severity to differentiate clinical presentations and response to exercise.     

Tibiofemoral joint forces during isokinetic knee extension

Using a Cybex II, eight healthy male subjects performed isokinetic knee extensions at two different speeds (30 and 180 deg/sec) and two different positions of the resistance pad (proximal and distal). A sagittal plane, biomechanical model was used for calculating the magnitude of the tibiofemoral joint compressive and shear forces. The magnitude of isokinetic knee extending moments was found to be significantly lower with the resistance pad placed proximally on the leg instead of distally. The tibiofemoral compressive force was of the same magnitude as the patellar tendon force, with a maximum of 6300 N or close to 9 times body weight (BW). The tibiofemoral shear force changed direction from being negative (tibia tends to move posteriorly in relation to femur) to a positive magnitude of about 700 N or close to 1 BW, indicating that high forces arise in the ACL when the knee is extended more than 60 degrees. The anteriorly directed shear force was lowered considerably by locating the resistance pad to a proximal position on the leg. This model may be used when it is desirable to control stress on the ACL, e.g., in the rehabilitative period after ACL repairs or reconstructions.     

Constant vs variable resistance knee extension training

To compare the effect of constant resistance (CR) and variable resistance (VR) training on full range-of-motion (ROM) strength development, 22 men and 27 women (age = 26 +/- 5 yr) were randomly assigned to either a CR training group (N = 17), a VR training group (N = 17), or a control group (N = 15) that did not train. The CR and VR groups trained 2 to 3 d.wk-1 for 10 wk. Subjects completed one set of full ROM (120 to 0 degrees of flexion) bilateral knee extensions with an amount of weight that allowed 8 to 12 repetitions during each training session. For the VR group, resistance was varied with a cam supplied by the manufacturer (Nautilus). For the CR group, the cam was removed and replaced with a round sprocket. Prior to and after training, maximal voluntary isometric torque was measured at 9, 20, 35, 50, 65, 80, 95, and 110 degrees of knee flexion. Analysis of covariance indicated that the VR and CR groups gained strength at all angles (P less than or equal to 0.05) when compared to the control. [table: see text] There was no difference (P greater than 0.05) between the CR and VR groups at any angle, and the magnitude of strength gained was similar (P greater than 0.05) among angles for both groups. These data indicate that both CR and VR knee extension training elicit full ROM strength development.