程序化麻醉下手法松解术治疗膝关节创伤术后关节粘连的21例临床报告

Procedural manipulation under anesthesia for joint adhesion after trauma of knee operation:report of21 cases

目的·探讨使用程序化麻醉下手法松解术(manipulation under anesthesia,MUA)治疗膝关节创伤术后关节粘连的临床疗效及安全性。方法·入选21例膝关节创伤术后关节粘连患者(包括膝关节多韧带损伤重建和/或修补术后6例、膝关节周围骨折内固定术后9例、髌骨脱位术后6例),行程序化MUA。使用关节量角尺评估患者在程序化MUA前、中、后随访(2周、12周、24周)的屈膝角度;使用视觉模拟评分法(visual analogue scale,VAS)评估患者在程序化MUA后2周内的疼痛程度;记录患者于程序化MUA中、后可能出现的并发症。结果·程序化MUA前、中、后随访(2周、12周、24周),患者的平均屈膝角度分别为73.8°、119.3°、101.7°、122.5°、127.4°。与术前相比,程序化MUA后24周的平均屈膝角度增加了53.6°。VAS评估结果显示,患者仅在术后1~3 d活动状态下的评分超过4分。术中及术后均未有并发症发生。结论·程序化MUA治疗膝关节创伤后关节粘连相对安全且有效。

Objective·To investigate the clinical efficacy and safety of procedural manipulation under anesthesia(MUA)for joint adhesion after trauma of knee operation.Methods·Twenty one patients with joint adhesion after trauma of knee operation(including 6 cases after reconstruction and/or repair of multiple ligament injury of knee joint,9 cases after internal fixation of fracture around the knee joint,and 6 cases after operation of patellar dislocation)were treated with procedural MUA.The knee flexion angle was evaluated before,during and after procedural MUA(2,12 and 24 weeks)with joint protractor.The pain degree was evaluated by visual analogue scale(VAS)within 2 weeks after procedural MUA.The possible complications were recorded during and after procedural MUA.Results·Before,during and after procedural MUA(2,12 and 24 weeks),the average knee flexion angle was73.8°,119.3°,101.7°,122.5°and 127.4°.Compared with preoperative,the average knee flexion angle increased 53.6°after procedural MUA(24 weeks).VAS evaluation results showed that the VAS score of patients in active state was more than 4 points only 1-3 days after operation.No complications occurred during and after the operation.Conclusion·Procedural MUA is relatively safe and effective in the treatment of joint adhesion after trauma of knee operation.