小切口结合关节镜松解治疗膝关节僵直

Treatment of ankylosis of the knee through a mini-incision assisted by arthroscope

目的:探讨小切口结合关节镜松解治疗膝关节僵直的临床效果。方法:2007年7月至2009年8月,采用小切口结合关节镜松解治疗膝关节僵直18例,男15例,女3例;年龄27～56岁,平均33.6岁。原手术前伤病:股骨远端粉碎性骨折5例,其中1例为开放骨折,胫骨平台粉碎性骨折9例,髌骨粉碎性骨折2例,髌骨粉碎性骨折并腓骨小头粉碎性骨折、膝外侧复合结构损伤1例,浮膝损伤1例。松解术距离首次手术时间6～31个月,平均10.6个月。松解后按照Judet的疗效评定标准进行疗效评估。结果:全部患者获随访,时间3～25个月,平均11.4个月。患者切口均Ⅰ期愈合,未出现感染,无缝线开裂,无切口皮缘液化坏死。手术前膝关节屈曲30°～80°,平均(44.72±11.60)°,术后屈膝角度95°～135°,平均(109.17±10.31)°。按照Judet的疗效评定标准,优16例,良2例。结论:小切口结合关节镜松解治疗膝关节僵直可以减少膝部切口并发症,创伤小,可早期行膝关节功能锻炼,关节功能恢复快,是治疗创伤、手术后膝关节僵直的一种较好方法。

Objective：To investigate therapeutic effects of mini-incision assisted by arthroscope for the treatment of ankylosis of knee. Methods：From July 2007 to August 2009,18 patients with ankylosis of knee were treated with mini-incision assisted by arthroscope. Among the patients,15 patients were male and 3 patients were female,ranging in age from 27 to 56 years,with an average of 33.6 years. Before operation,5 patients had comminuted fractures in the distal end of femur（including 1 patient with open fracture）,9 patients had comminuted fractures of tibial plateau,2 patients had comminuted fractures of patella,1 patient had comminuted fractures of patella combined with comminuted fracture of capitulum fibulae and injuries of complex structure at lateral knee,and 1 patient had floating knee. The duration between the primary operation and the arthrolysis ranged from 6 to 31 months（averaged,10.6 months）. The therapeutic effects were evaluated according to Judet criteria. Results：All the patients were followed up,and the duration ranged from 3 to 25 months （averaged,11.4 months）. All the patients had incision healing at the first stage without infection,wound dehiscence and liquifaction necrosis. The preoperative knee flexed motion ranged from 30° to 80°,with a mean of（44.72±11.60）°;and postoperative knee flexed range of motion improved to an average of （109.17±10.31）° （ranged,95° to 135°）. According to Judet evaluation,16 patients got an excellent result,2 good. Conclusion：Treatment of ankylosis of the knee through a mini-incision assisted by arthroscope has advantages such as reducing the complications of incision on knee,little trauma and early recovery,which is a good operative mode to treat ankylosis of the knee after operation or trauma.