创伤后膝关节松解术后关节活动度反弹现象及其影响因素

Factors related to re-falling of knee range of motion after arthrolysis for post-traumatic knee stiffness

目的分析创伤后膝关节僵硬松解术后关节活动度(ROM)恢复后又暂时下降(反弹)的现象及其影响因素。方法回顾性分析2016年7月至2019年9月北京博爱医院膝关节僵硬患者64例68膝,行微创膝关节松解术后随访12个月。测量患者术前,术后1周、6周、12周、6个月、12个月的膝关节屈伸ROM,采用特殊外科医院膝关节评分(HSS)进行评定,对反弹进行多元Logistic回归分析。结果术后患者膝关节屈伸ROM和HSS评分总体上改善;HSS评分呈持续性改善;术后6周时,膝关节屈伸ROM较术后1周下降,涉及44例46膝。手术时病程>12个月、复杂骨折、既往感染史与ROM反弹相关(OR>8.058,P<0.05)。结论微创膝关节松解术能改善膝关节僵硬患者的膝关节功能,但在康复过程中可能出现ROM反弹。手术不及时、骨折复杂、并发感染是反弹的风险因素。

Objective To observe the temporary loss(re-falling)of knee range of motion(ROM)during rehabilitation after arthrolysis for post-traumatic knee stiffness,and analyze the factors related to it.Methods From July,2016 to September,2019,64 patients(68 knees)in Beijing Bo'ai Hospital accepted minimally invasive arthrolysis for post-traumatic knee stiffness,and were followed up for twelve months.ROM of flexion and extension of knee was measured before operation,and one,six and twelve weeks,and six and twelve months after operation;while they were asssessed with Hospital for Special Surgery Knee Score(HSS).Multivariate Logistic regression was performed on re-falling.Results The ROM and HSS score improved as a whole after operation;however,HSS score improved constantly,but ROM decreased six weeks after operation compared with that one weeks after operation,involving 46 knees of 44 cases.Arthrolysis longer than 12 months from primary injuries,multiple complicated fracture and history of infection were the risk factors for re-falling(OR>8.058,P<0.05).Conclusion Minimally invasive arthrolysis is effective on knee function after arthrolysis for post-traumatic knee stiffness.However,re-falling of ROM may happen during rehabilitation.Delay of operation,multiple complicated fracture and history of infection may increase the risk of re-falling.