膝关节伸直位僵硬松解手术入路探讨

目的探讨采用多种手术入路进行膝关节伸直位僵硬松解的可能性。方法对22例膝关节伸直位僵硬采用手术松解治疗,其中16例采用原手术切口,包括外侧1例,前外侧9例,前内侧3例和前正中入路3例,对6例无法利用原手术切口松解的病人,5例采用前外侧切口,另1例电击伤后膝内侧异位骨化病人采用前内侧切口。结果应用多种手术入路股四头肌成形术均完成松解手术,17例病人切断了纤维化和挛缩的股中间肌。术中完全松解后可以达到的被动屈曲角度,除1例僵硬时间25年的病例松解到130°外,其他病人均达到150°以上。出院时膝关节主动屈曲度为101.8°±12.9°,与术前比较有显著提高(P0.01)。平均随访时间11.8(5~21)个月,随访结束时膝关节主动屈曲度112.5°±18.4°,较手术前明显增加(P(0.01);膝关节功能平均(95.7±4.5)分,明显高于术前(P0.01)。结论采用外侧、前外侧、前内侧和前正中等多种手术入路进行股四头肌成形术均可有效解除导致膝关节伸直位僵硬的因素,恢复膝关节的屈曲功能,术后积极康复在关节功能的恢复过程中起着十分重要的作用。

A Study of Surgical Approaches in the Release of Extension-contracture Ankylosis of the Knees

Objective To evaluate the possibility of using a variety of surgical approaches in the release of extension-contracture ankylosis of the knees.Methods Between June 2006 and June 2009,22 patients were treated with surgical release for extension-contracture ankylosis of the knees.Lateral,anterolateral,anteromedial,and anterior middle surgical approaches of the former operations were utilized in 16 patients.Of six patients which could not underwent former surgical incisions to release the ankylosis of the knees,5 were used the anterolateral approach and one caused by heterotopic ossification after electric shock underwent anteromedial approach to the knee.Results Quadricepsplasty was used to release all the patients.The fibrotic and shorten vastus medialis were incised in 17 patients.No patient was performed the elongation of quadriceps tendon.The patients could achieve more than 150 degrees of passive extension after comprehensive release in the operation,except that one patient with stiffness of 25 years got 130 degrees of maximal extension.The mean follow-up time was 11.8 months（range 5～21 months）.The range of flexion improved to（112.5±18.4） degrees（P0.01）.ConclusionsThe quadricepsplasty through lateral,anterolateral,anteromedial,and anterior middle surgical approaches can efficiently remove the factors of extension-contracture ankylosis of the knees,and restore the functional movements.The active rehabilitation after operation plays a significant role in the functional restoration of the knees.