膝关节镜术后粘连不同时间关节镜下松解治疗的疗效分析

Analysis of clinical effect of arthroscopic release at different time in treating knee adhesion after arthroscopic surgery

目的分析关节镜下松解术治疗膝关节镜术后粘连的疗效以及松解时间对疗效的影响。方法回顾性队列研究,入选2017年2月到2021年12月在北京大学第三医院接受关节镜下松解术的患者50例,男28例,女22例,年龄(30.8±11.9)岁。所有患者初次手术均为关节镜下手术。比较患者手术前、后的关节活动度(ROM),以及疼痛视觉模拟评分(VAS)、国际膝关节评分委员会(IKDC)评分和Tegner评分。以粘连症状出现到接受松解术的时间分为粘连病程<3个月组12例,3~6个月组16例,>6~12个月组14例和>12个月组8例,组间比较患者术后关节活动度、IKDC和Tegner评分,以及各指标的改善值。结果所有患者松解术后获得随访(36.4±19.7)个月。相比于术前,患者术后膝关节屈曲、伸直活动度、IKDC评分和Tegner评分均获改善[分别为125.0°±20.0°比75.7°±27.5°、2.3°±4.8°比7.4°±7.3°、(69.8±17.7)分比(51.4±12.8)分、(4.1±2.1)分比(2.2±1.1)分],差异均有统计学意义(均P<0.05),而VAS评分差异无统计学意义(P>0.05)。各组之间在伸直活动度、IKDC评分和Tegner评分及各指标改善值上差异亦均无统计学意义(均P>0.05)。两两比较发现,<3个月组和3~6个月组屈曲角度改善优于>12个月组(均P<0.05)。进一步将患者分为≤6个月组和>6个月组进行比较,≤6个月组随访时的屈曲活动度及其改善值优于随访>6个月组(分别为129.9°±20.0°比118.8°±17.4°、58.6°±32.8°比37.3°±23.1°),差异均有统计学意义(均P<0.05)。结论关节镜下松解术可作为膝关节镜术后粘连的有效治疗方法,粘连症状出现后应尽早干预,若保守治疗无进展,早期(6个月内)接受手术可获得更好的预后。

Objective To explore the efficacy of arthroscopic release in treating postoperative knee adhesion and investigate the influence of release timing on the treatment outcomes.Methods A total of 50 patients who accepted arthroscopic release in Peking University Third Hospital from February 2017 to December 2021 were included in the retrospective cohort.The study cohort comprised 28 men and 22 women,with a mean age of(30.8±11.9)years.All the primary surgeries were manipulated under arthroscopes.A comparison was made between pre-and postoperative range of motion(ROM),visual analog scale(VAS),International Knee Documentation Committee(IKDC)scores,and Tegner activity scale scores for the patients.According to the interval between the appearance of adhesion and arthroscopic release,the patients were divided into four groups:<3 months group(n=12),3-6 months group(n=16),>6-12 months group(n=14),and>12 months group(n=8).Inter-group comparisons on postoperative ROM,IKDC scores,and Tegner activity scale scores and improvement values of each outcome were conducted.Results All the patients were followed up for(36.4±19.7)months.Patients gained significant improvement in flexion,extension,IKDC scores,and Tegner scores(125.0°±20.0°vs 75.7°±27.5°,2.3°±4.8°vs 7.4°±7.3°,69.8±17.7 vs 51.4±12.8,4.1±2.1 vs 2.2±1.1)(all P<0.05),while the VAS scores did not show significant improvement.There were no significant differences among different groups in postoperative extension,IKDC scores or Tegner scores,nor in their improvements.However,patients in the≤6 months group could gain better postoperative flexion and improvement in flexion than those in the>6 months group(129.9°±20.0°vs 118.8°±17.4°,58.6°±32.8°vs 37.3°±23.1°)(P<0.05).Conclusions Arthroscopic release presents a great effect in treating knee adhesion after arthroscopic operation.Once the symptoms of adhesion appear and physical rehabilitation fails to improve the ROM,one should accept early surgical intervention(less than 6 months)for a better outcome.