运用馅饼皮技术经皮微创松解股四头肌治疗膝关节伸直挛缩

Minimally invasive pie-crusting technique combined with arthrolysis for the treatment of the stiff knee

目的 ：探讨经皮微创馅饼皮松解技术（pie crusting technique）结合关节粘连松解术应用于膝关节伸直挛缩患者的手术疗效。方法：回顾本院自2012年2月至2013年12月收住的13例膝关节伸直挛缩的患者,均采用髌旁内侧入路关节粘连松解术加经皮微创股四头肌馅饼皮松解术治疗。其中男6例,女7例;年龄39~70岁,平均55.6岁。其中骨折相关性关节僵直8例（4例为粉碎性胫骨平台骨折术后,3例为粉碎性股骨远端骨折术后,1例为髌骨骨折术后）,膝关节置换术后关节僵直5例。结果：13例术后均获随访,时间8~12个月,平均10个月。膝关节屈曲度术前平均（37±6）°,关节粘连松解术后（52±7）°,结合馅饼皮技术松解后（108±7）°,术后末次随访时（105±6）°,均较术前改善。根据Judet评分标准,优10例,良3例。使用馅饼皮技术松解后膝关节功能改善同穿刺针穿刺松解次数呈正相关（r=0.98）。术后无一例出现膝关节伸直滞缺、皮肤坏死、深部感染、再发关节僵硬和髌骨脱位等并发症。结论 ：经皮馅饼皮松解技术能有效改善膝关节伸直挛缩患者的膝关节活动度,是一种微创、简单、有效而又容易掌握的松解技术,值得推广。

Objective：To study the effectiveness of pie-crusting technique in improving the stiff knee. Methods：From February 2012 to December 2013,13 patients with stiff knee were reviewed retrospectively. There were 6 males and 7 females, ranging in age from 39 to 70 years old （averaged, 55.6 years old）. Of the 13 cases, 8 patients had stiffness following fracture （comminuted tibial plateau fracture in 4, femoral supracondylar fracture in 3 and patellar fracture in 1 ）, 5 patients had TKA- related stiffness. Results：A follow-up lasted 8 to 12 months （mean 10 months）in 13 cases. The mean maximum flexion in- creased from （37±6 ）° preoperatively to （ 52±7 ）° after arthrolysis, and （ 108±7 ）° after pie-crusting. At the final follow-up, mean maximum flexion was （105±6）°. According to Judet evaluation system, 10 patients got an excellent result and 3 good. No major complications, such as extensor lag, skin necrosis, deep infection, dislocation of the patella or recurrent stiffness were found. Conclusion：The percutaneous technique of pie-crusting is a simple, minimally invasive and effective treatment for knee stiffness.