摘要
目的探讨关节松解联合Ilizarov技术治疗创伤后膝关节纤维僵直的疗效,总结其适应证和注意事项。方法回顾性分析2012年1月至2020年12月期间国家康复辅具研究中心附属康复医院矫形外科采用关节松解联合Ilizarov技术治疗的9例(10膝)膝关节纤维僵直患者资料。男8例,女1例;年龄为15~42岁,平均30.2岁;膝关节僵直侧别:左侧2例,右侧6例,双侧1例。膝关节僵直均因膝关节周围损伤所致。受伤至本次就诊时间为12个月至38年,平均16.5年。入院检查膝关节伸直角度为-40°~0°,屈曲角度为-10°~40°。记录患者的外固定器佩戴时间、并发症发生情况,比较患者治疗前、后的膝关节活动度,末次随访时采用秦泗河肢体畸形残缺矫正术后评价标准评定疗效。结果9例患者术后获20~78个月(平均35个月)随访。外固定器佩戴时间为14~200 d,平均78.4 d。牵伸期间2例(3膝)患者出现外固定针道反应(3针孔),2例(2膝)患者出现针道感染(2针孔),1例患者切口愈合欠佳,无其他并发症发生。末次随访时患者膝关节功能恢复良好,伸直为0°,与术前(-6.5°±12.9°)比较,差异无统计学意义(t=-1.591,P=0.146);屈曲角度为70.0°±17.6°,与术前(15.0°±17.2°)比较,差异有统计学意义(t=-6.822,P<0.001)。末次随访时根据秦泗河肢体畸形残缺矫正术后评价标准评定疗效:优7膝,良3膝。结论对于创伤后膝关节纤维僵直单纯关节松解难以取得良好效果者,联合Ilizarov技术治疗可改善患者膝关节功能,规避严重并发症。
Objective To investigate the clinical efficacy and indications of arthrolysis plus Ilizarov technique in the treatment of traumatic fibrous stiffness of the knee.Methods The clinical data were analyzed retrospectively of the 9 patients(10 knees)with traumatic fibrous stiffness who had been treated by arthrolysis plus Ilizarov technique from January 2012 to December 2020 at Department of Orthopaedics,Rehabilitation Hospital of National Research Center for Rehabilitation Technique Aids.There were 8 males and one female,aged from 15 to 42 years(average,30.2 years).The left side was affected in 2 cases,the right side in 6 ones and bilateral sides in one.Their knee stiffness was all caused by injury around the knee.The time from injury to treatment ranged from 12 months to 38 years(average,16.5 years).The admission examination revealed that the knee extension ranged from-40°to 0°and the knee flexion from-10°to 40°.Wearing time for the external fixator and incidence of complications were recorded;the ranges of knee motion were compared before and after treatment;the Qin Sihe criteria for postoperative limb deformity correction were used at the last follow-up to evaluate the curative efficacy.Results The 9 patients were followed up for 20 to 78 months with an average of 35 months.The external fixators were worn for 14 to 200 days with an average of 78.4 days.During the traction period,pin tract reaction(3 holes)occurred in 2 patients with 3 knees,pin tract infection(2 holes)in 2 patients with 2 knees,the incision healed poorly in one patient,and no other complications occurred.The functional recovery of the knee was good at the last follow-up.The knee extension was 0°,insignificantly different from the preoperative value(-6.5°±12.9°)(t=-1.591,P=0.146);the flexion angle was 70.0°±17.6°,significantly better than the preoperative value(15.0°±17.2°)(t=-6.822,P<0.001).According to the Qin Sihe postoperative criteria,the curative efficacy at the last follow-up was excellent in 7 knees and good in 3.Conclusion In the treatment of traumatic fibrous stiffness of the knee,when the efficacy of simple arthrolysis is not good enough,a combination with Ilizarov technique can help improve the postoperative knee function and prevent severe complications.
作者
臧建成
石磊
郑学建
秦泗河
Zang Jiancheng;Shi Lei;Zheng Xuejian;Qin Sihe(Department of Orthopaedics,Rehabilitation Hospital of National Research Center for Rehabilitation Technique Aids,Beijing 100176,China;Qinsihe Orthopedics Institute,Beijing 100730,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2022年第6期464-470,共7页
Chinese Journal of Orthopaedic Trauma