关节镜下松解膝关节粘连的疗效观察

Arthroscopic releasing of knee stiffness

目的:观察膝关节粘连关节镜松解的适应症和临床疗效。方法:应用关节镜松解术治疗膝关节粘连患者24例,平均年龄44岁(17～71岁)。术前膝关节活动度10°～60°,平均37.5°,WOMAC评分9～22分,平均14分。术中使用等离子刀、钩刀及刨削器等在关节镜下进行粘连松解。术后镇痛、关节腔内注射玻璃酸钠、患肢主、被动功能锻炼及结合冰敷等治疗,观察膝关节活动度、功能、疼痛、肿胀及伤口愈合情况。结果:术中即刻被动活动度:50°～130°,平均101°,术后6周膝关节活动度70°～125°,平均98°,较术前平均改善60.5°;术后6周WOMAC评分0～17分,平均4.5分,较术前平均改善9.5分;按Judet疗效评定标准:优12例,良7例,可2例,差4例。术后切口均Ⅰ期愈合,未见其他并发症。术后关节活动度改善不明显的为:股骨髁上骨折、膝关节置换术后、关节功能障碍超过3月的患者。结论:单纯膝关节镜松解术能有效恢复3月内因关节内粘连导致的膝关节活动受限,对于股骨髁上骨折、膝关节置换术后、关节功能障碍超过3月的患者效果不佳,需要结合其他松解方式。

Objective：To study the indication and clinical efficacy of arthroscopic releasing of knee stiffness.Methods：24 cases of knee stiffness have undergone arthroscopic releasing.The mean age was 44 years（17～71） old.The average knee flexion angle was 37.5°（10°～60°） and WOMAC score was 14（9～22） preoperatively;intraoperatively,plasma knife was employed for intra-articular releasing.Postoperative rehabilitation protocol included CPM exercise,cold therapy,as well as anti-inflammatory analgesic treatment and intra-articular injection of hyaluronic acid sodium.The range of motion,joint swelling and complications were observed.Results：Intraoperatively,the average knee flexion angle was 101°（50°～130°）.6 weeks postoperatively,the average flexion angle was 98°（70°～125°）,which increased by 60.5° compared with preoperation;and the WOMAC score was 4.5（0～17）,which decreased by 9.5.Postoperatively,no obvious swelling or pain has been observed.Wound healing was uneventful.No complication has occurred.The average knee flexion angle was 98°（70°～125°）.With respect to the efficacy,according to Judet＇s criteria,excellent was in 12 cases,good in 7 cases,fair in 2 cases and poor in 4 cases.However,patients with supracondylar femoral fracture,joint replacement surgery and joint dysfunction for more than 3 months were liable to have poor prognosis.Conclusion：Arthroscopic releasing of knee stiffness can significantly improve the ROM of knee joint with intra-articular adhesions within 3 months.But other approaches may be necessary for the patients with supracondylar femoral fracture,joint replacement surgery and joint dysfunction for more than 3 months.