膝关节伸直受限的关节镜下治疗

Arthroscopic assisted diagnosis and treatment of knee extension limitation

目的 分析膝关节伸直受限的发病机制，探讨关节镜下诊治方法。方法分析2003年1月～10月在本院接受关节镜下手术303例患者的临床资料，通过关节镜确认引起膝伸直受限的直接病因，并根据关节镜下检查结果选择相应的手术方式。结果95例患者膝关节伸直受限，发生率为31．4％。创伤是最常见原因，占67．4％，主要为半月板和韧带损伤。另外，膝关节急、慢性关节内炎性病变也是较常见原因，按发生例数由高到低为：退变性骨关节炎、非特异性滑膜炎、滑膜软骨瘤病、类风湿关节炎、色素沉着绒毛结节性滑膜炎、痛风性关节炎及急性化脓性关节炎等。术后随访3～20个月，平均13．3个月，82例关节镜术后均可立即伸直，9例术后未立即伸直，经伸直锻炼后3周内均可伸直，4例随访1年以上不能完全伸直，4例复发。结论关节镜是诊断膝伸直受限的最佳手段，早期关节镜检查可获得满意疗效。

Objective To figure out the incidence and etiology of knee extension limitation and then to find out the proper methods of arthroscopic assisted diagnosis and treatment. Methods We reviewed 303 cases of axthroscopic assisted operation from January to October 2003, 95 cases of which suffered from knee extension limitation before operaion, including 54 male and 41female and the mean age was 36. 2 years old. The direct reasons of knee extension limitation were identified by routine arthroscopic examination and operations were carried out according to results of the examination. Results Incidence of knee extension limitation in this group of patients was 31.4%. Trauma, mainly meniscus and ligament injury accounted for 67.4%, which was the most common reason of knee extension limitation. Acute or chronic arthritis like degenerative arthritis, non-specific synonitis, synovial chonclromatosis, rheumatoid arthritis, pigmented villonodular synovitis, gouty arthritis and acute pyogenic arthritis formed another common reason. The follow-up period ranged from 3 to 20 months, average 13. 3 months. 82 cases gained full extension immediately after operation, 9 cases gained full extension after 3 weeks rehibilitation post-operation, 4 cases did not gain full extension 1 year after operation, recurrence was observed in 4 cases. Conclusions Arthroscopy is the best method for diagnosis of knee extension limitation at present. Satisfactory results can be expected after early arthroscopic assisted treatment.