肢体缓慢牵伸延长过程中膝关节功能的变化规律(英文)

Changing regularity of articular function in the slow lengthening process of limbs

背景:有报道肢体延长后关节活动功能障碍是最常见的并发症之一,但也有学者认为在合理的技术操作及有效的功能防护下肢体延长术后关节功能障碍完全可以避免。目的:探讨兔肢体延长过程中膝关节功能变化规律,为临床工作提供实验依据。设计:随机对照实验研究。单位:一所军医大学医院的骨科。对象:实验于2001-02/2002-06在第三军医大学实验动物中心完成。30只健康成年新西兰兔,第三军医大学实验动物中心提供。随机分为延长组及延迟观察组(停止延长3个月观察)。方法:各组按延长幅度不同又分别分为延长10%,20%及40%3个亚组。采用胫骨上干骺端1mm/d速度缓慢牵伸延长术。X射线确定延长幅度及膝关节影像学变化;测定延长终止及取材时膝关节屈伸范围。主要观察指标:延长前、延长终止时及延长终止3个月时兔膝关节活动度和X射线检查结果。结果:①各组不同时相点膝关节软骨未见明显影像学异常。②延长组中延长20%时出现显著性膝关节屈伸功能障碍(P<0.05),延长40%时仅为正常膝关节活动度的44.7%左右P<0.01);延迟观察组关节功(能均有显著性改善,其中延长20%组已恢复至延长前水平,而延长40%组也较延长终止时明显改善,但仍低于延长前正常水平,为正常水平的88.5%左右(P<0.05)。结论:肢体延长过程中可能出现暂时性关节功能障?

BACKGROUND:As reported in some literatures,articular dysfunction following lim b lengthening is one of the commonest complications, but some scholars believe t hat the articular dysfunction after lower limb lengthening is avoidable providin g appropriate technical operation and effective function prevention. OBJECTIVE:To investigate the changes of articular function of knee during limb lengthening in rabbits so as to provide a experimental basis for clinical tasks . DESIGN:A randomized controlled trial SETTING:Department of Orthopeadics,Affiliated Hospital of Some Military Medica l University. PARTICIPANTS:Study was conducted in the Experimental Animal Center of the Thir d Military Medical University of Chinese PLA from February 2001 to June 2002.Tot ally 30 healthy adult New Zealand rabbits obtained from the Experimental Animal Center of the Third Military Medical University of Chinese PLA were randomly div ided into lengthening group and delayed observation group(observed at 3 months a fter the stop of lengthening). METHODS:Every group was further divided into three sub groups according to di straction range:10%,20%and 40%.Upper tibia metaphysis distraction was adopte d at the rate of 1 mm per day .Distraction and iconography changes of knee joint were observed with X ray. The motive range of knee was investigated at the end of distraction and three months later. MAIN OUTCOME MEASURES:Articular motive range of the knee before the distractio n, at the end of distraction and three months later,X ray resutls RESULTS:①There was no obvious radiographic change in knee at every time point in each group.②Significant flexion disorder in knee was found in 20%distracti on subgroup(P< 0.05),which was only 44.7%of normal motive range in 40%distract ion subgroup(P< 0.01).Motive functions of knee in delayed observation group were significantly improved;thereinto,20%distraction subgroup returned to preoperat ive level,while 40%distraction subgroup also had significant improvement compar ed with that of 3 months earlier but still lower than normal level,which was onl y about 88.5%of normal level(P< 0.05). CONCLUSION:Temporary articular dysfunction might occur during limb lengthening process,and mostly during big range of distraction. Although the dysfunction co uld be gradually recovered after the stop of lengthening, active prevention is s till necessary.