小切口辅助关节镜下松解术对膝关节伸直型僵直的疗效分析

Study of combination of mini-incision and release technique under arthroscopy for treatment of knee extension stiffness

目的探讨小切口辅助关节镜下松解术治疗膝关节伸直型僵直的临床疗效。方法 2005年7月至2008年4月,以小切口辅助关节镜下松解术治疗17例膝关节伸直挛缩患者。术中先在关节镜下彻底松解关节内粘连,通过髌骨内外侧入路实行髌内、外侧支持带减压;再采取髌骨外上方的小切口行股四头肌-股骨纤维松解,解除膝关节内和关节外因素。术后第一天即开始规范的康复锻炼。结果术后随访6个月,17例患者中膝关节屈曲由术前的平均27.6°(5°～55°)增加到术后6个月平均屈曲度为103.2°(65°～120°),增加77.1°(35°～115°),与术前相比差异有统计学意义(t=-19.317,P<0.01)。手术前后平均Lysholm膝关节功能评分分别为55.4分和90.1分,术后相比术前差异有统计学意义(t=-13.220,P<0.01)。有2例患者屈膝功能改善不理想。结论小切口辅助关节镜下松解术有效改善膝关节伸直型僵直的屈膝角度和功能,具有创伤小、操作简便和并发症少的优点。

Objective To study a surgery of combination of mini-incision and release technique under arthroscopy for treatment of ankylosed extensor knee and evaluate the clinical outcome.Methods From July 2005 to April 2008,17 patients（17 knees） with ankylosed extensor knee were managed with release surgery.The surgery was composed of initial intra-articular arthroscopic lysis of the arthrofibrotic knee,subsequent extra-articular mini-invasion patellar decompression and quadricepsplasty so that it addressed all the intra-articular and limited extra-articular elements that block flexion of the knee.All patients underwent exercise one day after operation.Results At the time of the most recent follow-up（6-month postoperation）,the average flexion increased from 27.6°（5°～55°）preoperatively to 103.2°（65°～120°）postoperatively,with a increase of 77.1°（P0.01）.According to Lysholm Scores,the average knee score improved from 55.4 points preoperatively to 90.1 points（P0.01）. Two patients failed to get better results.Conclusion The surgery for me ankylosed extensor knee successfully increases me range of motion and enhances the functional outcome.It is mini-invasive,easy to operate and has less complications.