【摘要】 目的介绍一种治疗严重膝关节伸直挛缩的微创手术方法,探讨其临床疗效。方法1998年9月至2001年10月,共手术治疗22例膝关节伸直挛缩患者,手术包括小切口股四头肌成形术和关节镜清理术两部分。首先通过髌骨外上方的小切口行股四头肌成形术,逐步解除阻碍膝关节屈曲的关节内和关节外因素。在此基础上,再行关节镜下清理术。术后第1d即开始行功能锻炼。结果术后随访14￣63个月,平均42个月。22例患者中16例重度伸直挛缩患者行股四头肌肌腱延长术。膝关节屈曲由术前的平均27°(5°￣45°)增加到术后即刻的141°(120°￣150°);伸膝缺失由术前的平均0.9°(0°￣10°)减少到术后即刻的0.45°(0°￣5°)。随访结束时本组平均屈曲度为115°(75°￣150°),增加88°(45°￣125°),与术前相比差异有统计学意义(t=-19.317,P<0.01),平均伸膝缺失为1.1°(0°￣15°),增加0.2°。按照Judet标准,优16例,良5例,可1例。手术前后平均HSS膝关节功能评分分别为74分和94分。有1例患者切口发生浅表感染,另1例存在15°永久性伸膝缺失。结论该方法适用于大多数膝关节伸直型挛缩畸形,具有创伤小、并发症少、操作简单和疗效可靠等优点。它提供了一种全新的、能够替代传统方法的治疗手段。更多还原

【Abstract】 Objective To introduce a new minimally invasive surgery for the severely ankylosed extensor knee and evaluate the clinical outcome. Methods Between September 1998 and October 2001, 22 patients (22 knees) with severely ankylosed extensor knee were managed with minimal invasive surgery(16 males and 6 females). The mean age at the time of the operation was 37 years (range 14-66 years). To reduce the morbidity of both traditional and endoscopic methods of quadricepsplasty, this surgery was instituted for the treatment of severely ankylosed extensor knee, which was composed of initial extra-articular mini-invasive quadricepsplasty and subsequent intra-articular arthroscopic lysis of the arthrofibrotic knee, and addressed most intra-articular and extra-articular elements that block flexion of the knee, including actually shortening of the rectus femoris muscle. All patients underwent exercise one day after operation, and were evaluated with Judet’s criteria and the Hospital for Special Surgery knee-rating system. Results The follow-up duration was 14-63 months, with the mean time of 42 months. At the time of the most recent follow-up, the average flexion increased from 27° preoperatively to 115° postoperatively, the loss of extension decreased from 0.9° preoperatively to 0.45° postoperatively. At the end of following up, the average flexion was 115°, increasing 88°, but without significant difference; the average extension loss was 1.1°, decreasing 0.2°. According to Judet’s criteria, there was an excellent result in sixteen knees, a good result in five, and a fair result in one. And in terms of the Hospital for Special Surgery knee rating system, the average knee score improved from 74 points preoperatively to 94 points (P< 0.01). Superficial wound infection occurred in one patient. Only one patient had a persistent 15° extension lag. Conclusion Our new surgery for the severely ankylosed extensor knee successfully increases the range of motion and enhances the functional outcome. It provides an alternative mini-invasive approach and can be a substitute for traditional surgery.更多还原