膝关节僵直的关节镜下松解术

Arthroscopic release for knee joint ankylosis

[目的]探讨在关节镜协助下应用微创技术治疗膝关节僵直的优点。[方法]采用膝前内、前外及髌骨内上、外上4个5～10mm切口,先松解、扩张髌上囊创造出进入关节镜的空间,依照髌上囊→内、外侧沟→髌骨内、外侧支持带→髌股关节→髁间窝→膝关节内侧室→外侧室→股骨与股四头肌之间的粘连顺序进行松解。其间在保护下,辅以轻手法推拿、按摩。手法松解和镜下松解、清理交替反复进行,直至膝关节被动活动度满意为至。术后在CPM帮助下通过一定的康复程序进行康复。[结果]术后平均随访22个月(17～49个月),膝关节平均活动度为110°(95～130°),较术前平均增加75°(50～130°)。全部病人步态改善,跛行消失。关节稳定,髌骨没有脱位倾向,股四头肌肌力均在Ⅳ～Ⅴ级。无感染、皮肤坏死等并发症。[结论]关节镜下膝关节粘连松解术是一个创伤小、适应证广、安全有效、效果良好的治疗方法。

[ Objective] To investigate the advantages of arthroscopic release for knee joint ankylosis. [ Method ] With the help of arthroscopy, 35 knee joints with ankyloses began the operation from four approachings of 5 - 10 mm incisions, which were anteromedial of the knee, anterolateral of the knee, superiormedial of the patella, superiorlateral of the patella respectively. Then the suprapatella bursa was released and expand to make the arthroscopy enter in. Afterwards, releases were carried on by the sequences： suprapatellar bursa; medial and lateral channel; medial and lateral patellar retinaculum; patella/femoral joint; condyloid socket; medial and lateral chamber; adhesion between femoral and quadrieeps. During the operation, manual release and arthroscopic leading release alternated repeatedly until the motion of the knee joint resumed satisfactory. With the help of CPM, rehabilitation activities were practised postoperatively. [ Result ] All cases were followed up for an average of 22 months （ 17 -49 months）. The average flexion motion was 110 （95 - 130）, which increased by an average of 75 （50- 130） than that of preoperation. The gait improved and claudication disappeared in all patients. The quadriceps strength reached grade Ⅳ- Ⅴ without infection and necrosis of skin. [ Conclusion] Arthroscopic release has the advantages of less trauma, safety, and rapid rehabilitation. It is a satisfactory method to treat the knee joint ankylosis.