用伸膝装置多段切开延长和生物膜衬垫治疗膝伸直僵硬

Treatment of the Stiff Knee with Lengthening the Extensional Apparatus and Padding Biomembrane

伸膝僵硬严重影响患者的生活与工作。我们采用多平面腱部分切断术一次延长挛缩的伸膝装置,结合应用生物膜防止术后粘连,临床效果满意。14例患者,平均年龄28岁,膝关节活动范围平均20度。术后随诊16至24个月,平均18月,屈膝范围改善60至110度,平均85度。8只狗髌上囊部衬垫生物膜,术后光、电镜观察:早期生物膜基底部炎细胞浸润,1周后膜机化。生物膜光滑面无组织生长,表面光滑,基底粗糙面与其下组织愈合好。作者提出伸膝僵直早期治疗,防止关节退化性改变的必要性。本术式操作简便,术后关节功能改善明显,痛苦小,康复时间短,便于普及推广。

A newly designed operation consisted of lengthening the extensional apparatus of knee with multiple partial tendotomy and padding the biomembrane on the suprapatellar pouch was used for treatment of stiff knee. Fourteen patients with age from 10 to 40 (mean 28) were followed up for 16 to 24 months (Mean 18 months)after surgery. The result of treatment was satisfactory with the patient's knee flexion gaining from 20° to 60—100°, and average 85°. The experimental study was performed on 8 dogs and the biomembrane was padded on the suprapatellar pouch of each canine knee. Biopsy samples were examined with LM and SEM. The results showed that there was a nonspecific inflammatory cell infiltration in the basilar layer of the membrane in first few days. No new tissue grew on the smooth surface of membrane and the rough surface was well healed with underneath tissue. The authors propose that the early treatment of stiff knee is necessary to prevent degeneration of the joint.