股神经阻滞下手法松解术治疗全膝关节置换术后僵硬

Manipulation of knee stiffness under femoral nerve block following total knee arthroplasty

目的探讨股神经神经阻滞镇痛下手法松解术治疗全膝关节置换术后僵硬的临床疗效。方法自2013年1月至2017年12月,山东大学齐鲁医院(青岛)关节外科32例全膝关节置换术后僵硬的患者纳入本研究。在B超引导下连续股神经阻滞镇痛后行手法松解术,松解完毕后患者行主被动功能康复锻炼。记录术前及术后膝关节的屈曲度、美国膝关节学会评分(KSS)及功能锻炼时的视觉模拟评分法(VAS)评分。所得计量资料采用配对t检验。结果32例患者平均随访(20.4±3.1)周。松解前膝关节主动屈曲度平均(70.0±10.8)°,松解后末次随访主动屈曲度平均(106.4±7.9)°,平均改善(36.9±7.5)°(t=-28.5,P<0.05)。松解前KSS评分平均(78.3±2.3)分,松解后末次随访KSS评分平均(88.3±2.7)分,差异具有统计学意义(t=-27.1,P<0.05)。功能锻炼时VAS评分平均(4.5±1.1)分,为中度疼痛。随访无假体周围骨折、伸膝装置损伤、异位骨化等并发症。结论股神经神经阻滞镇痛下手法松解术能有效改善全膝关节置换术后僵硬,缓解患者功能锻炼时的疼痛,具有良好的临床效果和较低的并发症。

Objective To investigate the clinical effect of manipulation under femoral nerve block analgesia in the treatment of stiffness after total knee arthroplasty.Methods During January 2013 to December 2017,32 patients with stiffness after total knee arthroplasty were enrolled in this study.Ultrasound-guided continuous femoral nerve block were performed,followed by manipulation with passive knee flexion to the maximum extent,and functional rehabilitation exercises performed after manipulation.The knee flexion angle before and after manipulation,KSS scores and VAS scores during functional exercise were recorded.Results Thirty-two patients were followed up for(20.4±3.1)weeks on average.The knee flexion angle was mean of(70.0±10.8)°before manipulation,the knee flexion angle was(106.4±7.9)°on average at the last follow-up after manipulation under femoral nerve block analgesia(t=-28.5,P<0.05).The average improvement angle was(36.9±7.5)°.The average KSS score was(78.3±2.3)before manipulation,and was(88.3±2.7)at the last follow-up(t=-27.1,P<0.05).The VAS score during functional exercise was(4.5±1.1)on average,which was moderate pain.The patients were no periprosthetic fracture,extensor mechanism disruption or heterotopic ossification.Conclusion Manipulation was performed on patients with stiffness after knee arthroplasty under femoral nerve block analgesia can effectively improved knee function,and reduce the pain during manipulation.