摘要
目的通过对创伤后膝关节僵直康复治疗、关节镜松解和联合微创治疗方法的比较，选择合适的治疗方法。方法回顾性分析2004年2月至2009年11月的66例创伤后膝关节僵直患者的临床资料，男性36例，女性30例，年龄15～74岁，平均41岁；关节僵直时间为0．5～108．0个月，平均为15个月。其中康复组21例、关节镜组22例和联合微创组23例。对患者治疗前后的膝关节活动度（ROM）和美国特种外科医院（HSS）评分进行t检验，并分析其病变特点，包括病程、伸膝装置累及程度、体格检查及辅助检查结果等，归纳创伤后膝关节僵直的治疗方法。结果66例均获随访，随访时间24．0—72．5个月，平均34．2个月。三组患者治疗后的膝关节ROM均明显增加，其中康复组ROM由治疗前45°±22°增加到治疗后的95°±24°t=-11．2，P〈0．05）；关节镜组由术前的47°±26°增加到术后的118°11°t=-11．0，P〈0．05）；联合微创组由术前的36°±22°增加到术后的110°±14°（t=-13．4，P〈0．05）。各组治疗前后HSS评分比较差异均有统计学意义（z=-9．1、-6．0、-5．2，P〈0．05）。未出现皮肤坏死、撕裂、伤口裂开、再骨折情况，有短期伸膝滞留现象，但最终随访时无伸膝迟滞遗留；末次随访时按Judet标准，康复组优15例，良3例，可3例；关节镜组优15例，良5例，可2例；联合微创组优14例，良8例，差1例。结论创伤后膝关节僵直的病理特征复杂，要根据患者的不同情况制定个体化治疗方案，且适时有效地将手术介入和正规系统的康复治疗相结合，是获得满意疗效的关键。
Objectives To investigate the therapeutic effect of rehabilitation, arthroscopy and ＂hybrid technique＂ for posttraumatic knee stiffness （PTKS） , and to make the best choice for the treatment. Methods From February 2004 to November 2009, 66 patients suffered from PTKS were treated, and the clinical data were studied retrospectively, 36 male and 30 female patients with an average age of 41 years were analyzed, knee stiffness time averaged 15 months（0. 5-108.0 months） ,21 cases of patients were treated with rehabilitation （rehabilitation group ）, 22 cases of patients with arthroscopy ＋ rehabilitation （arthroseopy group） and 23 cases of patients with mini-invasive ＂hybrid technique＂ ＋ rehabilitation （hybrid technique group）. For each case, the difference of range of motion（ROM） and hospital for special surgery （HSS） score of the knee before and after the treatment were analyzed statistically. The characters of PTKS including the course of the disease, the degree of extensor mechanism involving, physical examination and other ancillary data were also analyzed. The management methods for PTKS were summarized. Results Total 66 cases were followed up ranging from 24. 0-72. 5 months and the mean time was 34. 2 months. The average ROM was improved obviously： rehabilitation group increased from 45° ± 22° to 95° ± 24° （ t = -11.2,P〈0.05）,arthroscopy group from 47° ±26° to 118° ± 11 °（t = - 11.0,P 〈0.05）and hybrid technique group from 36° ± 22° to 110° ± 14°（ t = - 13.4,P 〈 0. 05 ）. Both ROM and HSS score of the knee before and after the treatment for each group showed significant difference statistically （ t = - 9. 1, - 6. 0,-5.2,P 〈0. 05）. Wound necrosis, tearing, re-fracture and extension lag were not found. According to Judet standard at final follow-up, 15 cases were excellent,3 cases good and 3 cases normal in rehabilitation group;15 cases were excellent, 5 cases good and 2 cases normal in arthroscopy group; 14 cases were excellent,8 cases good and 1 case bad. Conclusions Pathology of PTKS is complex, satisfactory result could be obtained through individualized treatment program, which were established depend on the course of the disease, the degree of extensor mechanism involving, physical examination and ancillary data. The timely and effective surgical interference followed by a comprehensive rehabilitation program is the key point for satisfied outcome.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2012年第9期814-817,共4页
Chinese Journal of Surgery
基金
财政部基本科研业务专项基金资助项目（2009c-08）
关键词
膝损伤
膝关节
关节强直
康复
关节镜检查
外科手术
微创性
Knee injuries
Knee joint
Ankylosis
Rehabilitation
Arthroscopy
Surgical procedures, minimally in vasive
