伸直型膝关节僵硬的关节镜下松解术

膝关节粘连又称伸膝装置粘连,是膝关节及关节周围创伤及手术后的严重并发症,既往多采用膝关节切开粘连松解股四头肌成形术治疗,但由于创伤大愈合慢术后剧烈疼痛造成无法进行早期关节功能锻炼,严重影响治疗.80年代初,国际上一些学者[1,2]采用关节镜下膝关节粘连松解术,取得满意疗效.90年代后期,国内开始有少量报道[3].自2002年4月至2004年6月,笔者采用关节镜直视下松解治疗膝关节粘连10例,临床疗效满意.     

Judet股四头肌成形术治疗膝关节伸直位僵硬24例

膝关节伸直位僵硬是严重股骨骨折的内固定术后常见一种并发症,易导致膝关节屈曲功能障碍。自2005年3月~2010年3月,笔者采用Judet股四头肌成形术治疗膝关节伸直位僵硬24例,取得满意疗效。     

逆行阔筋膜蒂脂肪瓣股四头肌成形术治疗膝关节僵硬

逆行阔筋膜蒂脂肪瓣股四头肌成形术治疗膝关节僵硬冯峰，王新卫采用股四头肌成形术治疗膝部僵硬是目前较为理想的方法［１，２］，但术后易形成新的粘连，影响膝关节功能恢复。自１９９１年４月，我们设计了逆行阔筋膜蒂脂肪瓣股四头肌成形术，治疗创伤后膝关节伸直位僵硬...     

伸直型膝关节纤维性僵硬松解术

我院骨科自１９８９年以来，应用伸膝装置粘连松解及术后应用下肢功能康复机活动膝关节防止粘连，治疗膝关节僵直３０例，效果良好。临床资料１．一般资料：本组男２３例，女７例；年龄２３～５０岁；病程６个月～２年。病因：股骨干或股骨下端骨折１５例，骸骨骨折３例，胫腓骨骨折５例，股骨干骨折并胫腓骨骨折５例，股骨颈及股骨干骨折２例。２．手术方法，大腿中部起绕髌骨内侧至胫骨结节“Ｓ”形切口。先将股直肌与股内、外侧肌分离，探查股中间肌及髌上囊，松解粘连，沿股四头肌与股骨骨膜之间向远端分高粘连．将骸骨两侧挛缩的支持带…     

股骨远端骨折术后伸直性膝关节僵硬的治疗及影响因素分析

目的探讨股骨远端骨折术后伸直性膝关节僵硬的手术疗效,并分析其影响因素。方法对自2006年5月~2011年12月采用关节镜联合小切口粘连松解术治疗的17例股骨远端骨折术后伸直性膝关节僵硬进行回顾性研究,采用Judet疗效评定标准评价膝关节功能,并对股骨远端骨折术后发生膝关节僵硬的诸多因素及影响粘连松解术后疗效的相关因素进行分析。结果本组获随访6～73个月,平均31个月。末次随访时膝关节功能根据Judet疗效评定标准:优9例,良7例,可1例。术中及末次随访时膝关节活动度与术前膝关节活动度比较明显改善(P<0.05),粘连松解术的疗效与术前膝关节的活动度、松解术的手术时期、术中松解程度有关。结论应用关节镜联合小切口粘连松解术,辅以早期功能锻炼是治疗股骨远端骨折术后伸直性膝关节僵硬较有效的方法,其手术创伤小、术后功能康复良好、并发症少。     

关节镜技术联合改良小切口松解术治疗膝关节僵硬

目的 探讨关节镜技术联合改良小切口松解术治疗膝关节僵硬的临床疗效.方法 回顾性分析自2011-06-2017-12采用关节镜技术联合改良小切口松解术治疗的14例膝关节僵硬,采用关节镜对膝关节内粘连结构进行松解,采用改良小切口Zhao松解术完成膝关节外粘连松解.结果 14例均获得随访,随访时间平均14.6(12～24)个...     

伸直型膝关节僵硬Judet式松解术38例体会

目的探讨Judet式松解术对伸直型膝关节僵硬疗效.方法按照Judet介绍的方法彻底松解膝关节内外粘连,股中间肌和股外侧肌从股骨粗隆下起始环形切断后下移重建股四头肌治疗38例.结果38例随访1年3个月～9年,术后膝关节伸屈活动度平均增加75°,平均屈膝度为97°.结论Judet式松解术较彻底松解膝关节内外粘连,无须切断股中间股,保存了股四头肌解剖和功能的完整性,是一种疗效肯定的治疗方法.     

膝关节伸直位僵硬的手术治疗

对20例膝关节伸直位僵硬患者采用手术治疗，经术后1～2年以上随诊，疗效满意。手术中应彻底松解关节内和关节外的粘连，重点是游离股直肌，切除瘢痕化之股中间肌。术前应仔细地评价股四头肌的肌力。膝关节伸直位僵硬的病理改变是股中间肌、股直肌粘连与挛缩，髌两侧支持带的挛缩，髌股关节粘连，髌上囊的粘连，股胫关节粘连、强调手术后早期功能锻炼是恢复关节功能的关键。     

股四头肌成形术治疗重度膝关节僵直

膝关节僵直是临床上的常见病，其主要原因是伸膝装置的挛缩与粘连。近3年来，我科应用股四头肌成形与膝关节松解治疗膝关节僵直23例，取得较好的效果。 1临床资料 本组23例，男18例，女5例；年龄22～59岁，平均29岁；病因：股骨干中下段骨折术后15例（其中6例为骨不连接）；     

Arthrography in extension stiffness of the knee joint

In the present paper the authors point out in the importance of arthrography in the preoperative diagnosis of stiffness of the knee joint; their findings are based on a study of 29 cases. The majority of the roentgenograms show the knees of patients who subsequently underwent surgical arthrolysis. The technique and special features of the procedure are described. The evaluated contrast films may be classified in three groups, the first including joints with a residual mobility of up to 50 degrees, the second including those with between 50 and 90 degrees and the third those with more than 90 degrees. Typical for the first group is an obliteration of the upper recessus and an omega-shaped form in AP films. Films from Group 2 only show constrictions of the recessus suprapatellaris. In the third group only slight changes are found, which in some cases could only be assessed more accurately by comparison with the healthy side. In cases of knee-joint stiffness due to extra-articular causes there is no correlation between the arthrogram and the range of mobility. The authors conclude that X-rays of the interior of the joint using contrast medium can be a valuable help in planning surgical treatment for fibrotically stiffened knee joints.     

中西医结合治疗膝关节粘连性强直的研究进展

膝关节粘连性强直是膝关节或膝关节周围创伤或术后因制动时间长、缺少功能锻炼、不正确的功能锻炼及不恰当的内固定等引起的严重并发症,如今已是临床上一种常见病与多发病,严重影响患者的日常生活及工作,患者不仅痛苦,且给家庭和社会造成很大影响。因此,近年来国内外学者对该病的研究十分重视,并且取得了很大的进步。同时经过众多临床工作者的不懈努力,在总结传统治疗方法的基础上,开创了一些更为有效、安全的治疗方法。笔者将近几年内治疗粘连性膝关节强直的中西医方法作一阐述,望能够指导更多的临床工作者灵活运用,最大限度地减轻患者的痛苦,为社会带来更多的福音。     

Arthrolysis in the treatment of post-traumatic joint stiffness of the knee and elbow joints

In the treatment of posttraumatic limitation of the range of motion, arthrolysis is a proved procedure in the hand of an experienced surgeon. In this paper, indication, operative details and postoperative treatment are discussed. The results of 51 cases of arthrolysis of the knee joint and 33 cases of arthrolysis of the elbow joint carried out over a time of seven years are reported.     

Arthrolysis as a surgical treatment concept of post-traumatic stiffness of the knee joint

In the period from 1977 to 1989 105 arthrolyses were performed in 102 patients. There were mainly posttraumatic fibroarthroses: 51 consecutive to fractures, 39 after ligamentous injuries, 13 post-infectious of which 11 were also post-traumatic and only 2 patients with rheumatological diseases. Remarkable is the increased number of fibroarthrosis after polytrauma (n = 26). The preoperative range of motion was under 30 degrees in 26 patients and 48 patients had a severely limited range of motions between 30 and 60 degrees. The follow-up examination performed in an average of 2 years after the operative mobilization showed that the initial mobility was more than doubled. These results are related to atiology, operative procedure and degree of severity of the preoperative stiffness. Fair to excellent results were obtained in almost 3/4 of the patients. We explain these results by an adapted extraarticular or combined procedure which were used in 63 cases. The open release is backed by an intensive rehabilitation program in which painlessness through PDA and an immediate postoperative continuous passive motion are of most importance.     

改良关节松解治疗股骨远端骨折术后膝关节强直

[目的]探讨创伤术后改良膝关节粘连松解结合透明质酸钠关节内注射对治疗膝关节粘连性强直的价值。[方法]对22例膝关节僵硬患者行膝关节改良粘连松解,18例患者行传统膝关节松解术,术后关节腔内均注射透明质酸钠,并早期CPM锻炼,观察术后膝关节伸屈活动度改善程度。[结果]2组术后关节功能依照HSS膝关节评分标准进行评价,改良组优良率高于对照组,且无发生髌骨骨折、伸膝无力、感染等并发症。[结论]膝关节创伤术后的改良粘连松解术处理膝关节僵硬是一项有效、可靠和安全的技术,结合透明质酸钠关节内注射能有效减轻或预防术后再粘连的形成,有助于膝关节功能康复。     

Mobilization in anesthesia and arthrolysis in postoperative knee joint stiffness

Knee joint stiffness first of all calls for physiotherapy, ranging from exercise therapy to a passive-immobilization splint. If no progress can be achieved, narcosis mobilization and brisement modéré should be done. If narcosis mobilization does not yield acceptable results, then surgical dissolution and arthrolysis should be performed. Thirty-seven patients with painless fibrous knee-joint stiffness following ligament reconstructions showed a reduction in mobility of 0 degree-20 degrees-80 degrees on average. After narcosis mobilization, full extension and bending could be achieved in 28 patients. In 9 patients, arthrolysis had to be carried out. At follow-up examination 1/2 to 3 1/2 years later, all 37 patients showed an increase in movement of 0 degree-0 degree-125 degrees on average. The "relative gain," the quotient of achieved and possible gain of movement in percentage, ranged from 88% to 96% on average. Other kind of loss of movement, patient age, or sex had no influence on the results. Twenty-six patients were able to participate in sports again due to the increase in movement potential. In the last few years, we have come to prefer arthroscopical arthrolysis instead of surgical arthrolysis when narcosis mobilization fails.     

Comparison between two methods of drain clamping after total knee arthroplasty

Introduction To study the clinical outcome of two methods of drain clamping after total knee arthroplasty and to determine the effect on blood loss and blood transfusion.Patients and methods A prospective study involving 73 patients, randomized into two groups. Group 1 included patients in whom the drain was clamped for 1 h postoperatively, after which it was released and kept open for 48 h. Group 2 included patients in whom the drain was clamped and released for 10 min every 2 h for 24 h. The drain was removed at 48 h in both groups. Patients demographic details, intraoperative and postoperative blood loss, and haemoglobin values on the preoperative and postoperative days (1, 4, 7, 14) were recorded.Results The mean postoperative drainage in group 1 was 520.65±170 ml, which was significantly higher than that of group 2, 367.62±141.1 ml (p<0.05, Students t-test). The drain charting shows 65% of drainage volume occurs in the first 8 h in both groups. The study suggests a reduction in the incidence of blood transfusion in the 2-hourly groups, although it was not statistically significant. There was a difference in the haemoglobin drop between both groups, but statistically the p value was marginally above 0.05 (p=0.086) and hence not significant.Conclusion The method of 2-hourly clamping of drain and release for 10 min significantly reduces postoperative blood loss, without any added increase of complication, after total knee arthroplasty.