创伤性膝关节功能障碍的治疗

目的：探讨创伤后膝关节功能障碍（PKJD）的综合治疗及疗效。方法：了解本院骨科创伤后膝关节功能障碍患者83例（90膝）。治疗包括系统正规的康复手段以及手术介入。康复手段包括肌力训练、关节活动范围训练、神经生理治疗技术、身体适应性训练等；手术介入包括传统的伸膝装置黏连松解、内固定物取出同时黏连松解、小切口有限股四头肌成形＋关节镜松解、Ilizarov技术、工人膝关节置换术（治疗严重创伤后晚期膝关节功障碍）。结果：90例住院均未进行正规的康复治疗，入院后68例行康复治疗，22例手术治疗。平均膝关节活动度（ROM）入院时0°-9．5°-56．3°，股四头肌肌力Ⅲ～Ⅳ级；出院时0°-4．7°-89．8°，股四头肌力Ⅴ级，治疗前后膝关节ROM相比较有统计学差异（P〈0．01）。30例出院时仍残留5°-10°膝关节伸直迟滞，5例应用Ilizarov技术治疗效果欠满意，3例治疗过程中出现精神抑郁症。73例平均20．5月随访时膝关节均能伸直到0°，其中屈曲≥120°者10例。结论：①原始创伤处理不当和治疗后未行早期系统正规的康复训练是造成创伤后膝关节功能障碍不可忽视的原因；②康复治疗和适当的手术介入可取得良好的效果；③工人膝关节置换术是治疗膝关节创伤后晚期严重功能障碍是一种有效的方法。

Clinical study of the management of posttraumatic knee joint dysfunction

Objective： To evaluate the comprehensive clinical management of posttraumatic knee joint dysfunction（ PKJD ）. Method： From 2003 to 2008, 83 patients （ 90 knees ） with posttraumatic knee joint dysfunction were treated with conservative procedures including training of muscle strength, range of motion （ ROM ） , proprioception or neuromuscular control, general physical condition;and surgical procedures including Thompson＇s procedures, improved Judet Is technique, extra-articular mini -invasive quadricepsplasty ＋ intra- articular arthrofibroticlysis, Ilizarov technique, total Knee arthroplasty. Result ： All of the 90 cases did not receive systematic rehabilitation therapy before they came in hospital. At our center, 68 of them were managed conservatively and 22 of them surgically. The average ROM of the involved knee was 0° - 9.5° - 56.3° at the time of admission, and 0° - 4.7° - 89.8° when they were discharged, the difference is significant statistically （ P 〈0.01）. 30 cases remained 5° - 10°knee extension lag. 5 cases who were treated with Iizarove technique showed uncomfortable results, and 3 cases got psychosocical problem. 73 cases were followed up in average 20.5 months and all the knees were able to extend to 0°. Conclusion：Unable to receive ideal surgical treatment after trauma and systematic rehabilitation therapy after surgery are the very important factors of posttraumatic knee joint dysfunction ,the management of PKJD is difficult and time consuming, systematic rehabilitation programs and adequate surgical intervention induce good results. Knee arthroplasty knee injuries after treatment were late serious function obstacle is a kind of effective method.