摘要
背景：全膝关节置换术后初期对部分屈曲角度不能超过90°的患者可能须进行麻醉下的手法松解，以改善关节活动度。本目的是评价全膝置换术后手法松解的治疗效果。方法：90例患者（113膝）因术后平均10周时患膝屈曲角度≤90。而进行了手法松解。分别于全膝关节置换术之前、手术、手法松解前、手法松解后即刻以及术后6个月、1年、3年、5年以量角器测量膝关节的屈曲角度。黑：90例患者中81例（90％）在手法松解后膝关节屈曲角度获得改善。膝关节平均屈曲角度在全膝关节置换术前102°，中皮肤缝合后111°，手法松解前70°。术后5年随访时膝关节屈曲角度较手法松解前平均提高35°（p〈0．0001，配对t检）。术后12周之内进行手法松解的患者与术后12周之后进行手法松解的患者相比，平均屈膝角度的改善程度无显著差，最终仍进行手法松解的患者其术前膝关节协会疼痛评分明显低于未进行手法松解的患者（更痛，p=0．0027）。结论手法松解可以改善全膝关节置换术后膝关节屈曲角度。术前疼痛明显的患者术后更趋向于须手法松解。可信水平：治疗性研究，Ⅲ级。进一步可信度参见作者介绍。
Background： Following total knee arthroplasty, some patients who fail to achieve 〉90° of flexion in the early perioperative period may be considered candidates for manipulation of the knee under anesthesia. The purpose of this study was to assess the outcomes of manipulation following total knee arthroplasty. Methods： One hundred and thirteen knees in ninety patients underwent manipulation for postoperative flexion of ≤〈90° at a mean of ten weeks after surgery. Flexion was measured with a goniometer prior to total knee arthroplasty, at the conclusion of the operative procedure, before manipulation, immediately after manipulation, at six months, and at one, three, and five years postoperatively. Results： Eighty-one （90%） of the ninety patients achieved improvement of ultimate knee flexion following manipulation. The average flexion was 102° prior to total knee arthroplasty, 111° following skin closure, and 70° before manipulation. The average improvement in flexion from the measurement made before manipulation to that recorded at the five-year follow-up was 35° （p 〈 0.0001, paired t test）. There was no significant difference in the mean improvement in flexion when patients who had manipulation within twelve weeks postoperatively were compared with those who had manipulation more than twelve weeks postoperatively. Patients who eventually underwent manipulation had significantly lower preoperative Knee Society pain scores （more pain） than those who had not had manipulation（p = 0.0027）. Conclusions： Manipulation generally increases ultimate flexion following total knee arthroplasty. Patients with severe preoperative pain are more likely to require manipulation. Level of Evidence： Therapeutic Level Ⅲ. See Instructions to Authors for a complete description of levels of evidence.
