中国修复重建外科杂志

中国修复重建外科杂志

开放松解术治疗初次人工全膝关节置换术后关节僵硬

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目的探讨开放松解术治疗初次人工全膝关节置换术后晚期膝关节僵硬的疗效。方法2014 年 1 月—2017 年 10 月,收治 7 例(7 膝)初次 TKA 术后晚期膝关节僵硬的女性患者。年龄 57~71 岁,平均 63 岁。左膝 2 例,右膝 5 例。患者均因膝关节骨关节炎行 TKA;TKA 与开放松解术间隔 8~30 个月,平均 13.6 个月。术前 4 例膝关节伸直受限 10~20°;患者膝关节活动度为(54.3±12.1)°。美国膝关节协会评分(KSS)临床、功能评分及总分分别为(76.3±7.6)、(67.9±11.1)、(144.1±16.1)分。采用开放松解术治疗,术中彻底清除增生瘢痕组织,恢复关节活动度,维持屈曲、伸直间隙平衡及良好的髌骨轨迹;术后严格功能康复。结果术后患者切口均 Ⅰ 期愈合,无术后早期并发症发生。患者均获随访,随访时间 12~32 个月,平均 20.1 个月。X 线片复查示假体均未见异常。患者膝关节活动均较术前明显改善,术后仅 1 例膝关节活动度<90°,1 例膝关节存在 10° 伸直受限。末次随访时,膝关节活动度为(92.9±4.9)°,KSS 临床、功能评分以及总分分别为(81.9±5.1)、(74.3±9.8)、(156.1±13.7)分;以上指标均优于术前,差异有统计学意义(P<0.05)。结论对于初次 TKA 术后晚期膝关节僵硬患者,开放松解术联合术后功能康复能有效恢复膝关节功能。

ObjectiveTo evaluate the effectiveness of open arthrolysis in treatment of the patient with stiff knee in late stage after primary total knee arthroplasty (TKA).MethodsBetween January 2014 and October 2017, 7 female patients (7 knees) with stiff knee in late stage after primary TKA were admitted. The patients were 57-71 years old (mean, 63 years). There were 2 left knees and 5 right knees. All patients underwent TKA because of knee osteoarthritis. The interval between TKA and open arthrolysis was 8-30 months (mean, 13.6 months). There were 4 patients with 10-20° of extension deficit before arthrolysis. The range of motion of knee was (54.3±12.1)°. The clinical score, functional score, and total score of Knee Society Score (KSS) before arthrolysis were 76.3±7.6, 67.9±11.1, and 144.1±16.1, respectively. During the arthrolysis, periarticular soft tissue scar was removed, the range of motion of knee was restored, the gap balance and well patellar tracking were maintained. Intensive rehabilitation after operation was supplemented.ResultsAll wounds healed by first intention, without early stage complications. All patients were followed up 12-32 months with an average of 20.1 months. No abnormality of prosthesis was found by post-operative X-ray films. The knee movement improved significantly when compared with that before arthrolysis. The range of motion was less than 90° in 1 patient and 10° of extension deficit remained in 1 patient after operation. The range of motion was (92.9±4.9)° at last follow-up. The clinical score, functional score, and total score of KSS were 81.9±5.1, 74.3±9.8, and 156.1±13.7, respectively at last follow-up. The above indexes were superior to those before operation (P<0.05).ConclusionOpen arthrolysis combined with intensive rehabilitation is a significant way to improve knee function for the patient with stiff knee in late stage after primary TKA.

关键词: 人工全膝关节置换术; 关节僵硬; 关节松解; 并发症

Key words: Total knee arthroplasty; stiff knee; arthrolysis; complication

引用本文: 蒋其宏, 胡懿郃, 曾敏, 谢杰. 开放松解术治疗初次人工全膝关节置换术后关节僵硬. 中国修复重建外科杂志, 2019, 33(3): 307-311. doi: 10.7507/1002-1892.201808092 复制

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1. Cheuy VA, Foran JRH, Paxton RJ, et al. Arthrofibrosis associated with total knee arthroplasty. J Arthroplasty, 2017, 32(8): 2604-2611.
2. Kornuijt A, Das D, Sijbesma T, et al. Manipulation under anesthesia following total knee arthroplasty: a comprehensive review of literature. Musculoskelet Surg, 2018, 102(3): 223-230.
3. Vanlommel L, Luyckx T, Vercruysse G, et al. Predictors of outcome after manipulation under anaesthesia in patients with a stiff total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2017, 25(11): 3637-3643.
4. Cohen JS, Gu A, Lopez NS, et al. Efficacy of revision surgery for the treatment of stiffness after total knee arthroplasty: A systematic review. J Arthroplasty, 2018, 33(9): 3049-3055.
5. Hug KT, Amanatullah DF, Huddleston JI, et al. Protocol-driven revision for stiffness after total knee arthroplasty improves motion and clinical outcomes. J Arthroplasty, 2018, 33(9): 2952-2955.
6. Moya-Angeler J, Bas MA, Cooper HJ, et al. Revision arthroplasty for the management of stiffness after primary TKA. J Arthroplasty, 2017, 32(6): 1935-1939.
7. Bodendorfer BM, Kotler JA, Zelenty WD, et al. Outcomes and predictors of success for arthroscopic lysis of adhesions for the stiff total knee arthroplasty. Orthopedics, 2017, 40(6): e1062-e1068.
8. Fitzsimmons SE, Vazquez EA, Bronson MJ. How to treat the stiff total knee arthroplasty?: a systematic review. Clin Orthop Relat Res, 2010, 468(4): 1096-1106.
9. Manrique J, Gomez MM, Parvizi J. Stiffness after total knee arthroplasty. J Knee Surg, 2015, 28(2): 119-126.
10. Kim J, Nelson CL, Lotke PA. Stiffness after total knee arthroplasty. Prevalence of the complication and outcomes of revision. J Bone Joint Surg (Am), 2004, 86-A(7): 1479-1484.
11. Yercan HS, Sugun TS, Bussiere C, et al. Stiffness after total knee arthroplasty: prevalence, management and outcomes. Knee, 2006, 13(2): 111-117.
12. Scranton PE Jr. Management of knee pain and stiffness after total knee arthroplasty. J Arthroplasty, 2001, 16(4): 428-435.
13. Donaldson JR, Tudor F, Gollish J. Revision surgery for the stiff total knee arthroplasty. Bone Joint J, 2016, 98-B(5): 622-627.
14. Heesterbeek PJ, Goosen JH, Schimmel JJ, et al. Moderate clinical improvement after revision arthroplasty of the severely stiff knee. Knee Surg Sports Traumatol Arthrosc, 2016, 24(10): 3235-3241.
15. Mont MA, Seyler TM, Marulanda GA, et al. Surgical treatment and customized rehabilitation for stiff knee arthroplasties. Clin Orthop Relat Res, 2006, (446): 193-200.
16. Hutchinson JR, Parish EN, Cross MJ. Results of open arthrolysis for the treatment of stiffness after total knee replacement. J Bone Joint Surg (Br), 2005, 87(10): 1357-1360.
17. Kalson NS, Borthwick LA, Mann DA, et al. International consensus on the definition and classification of fibrosis of the knee joint. Bone Joint J, 2016, 98-B(11): 1479-1488.
18. Vun SH, Shields DW, Sen A, et al. A national questionnaire survey on knee manipulation following total knee arthroplasty. J Orthop, 2015, 12(4): 193-196.
19. 侯晓玲, 罗泽宇, 王浩洋, 等. 收肌管阻滞麻醉联合局部浸润麻醉镇痛对初次人工全膝关节置换术后康复的影响. 中国修复重建外科杂志, 2018, 32(8): 1006-1011.
20. Kumar L, Kumar AH, Grant SA, et al. Updates in enhanced recovery pathways for total knee arthroplasty. Anesthesiol Clin, 2018, 36(3): 375-386.
21. Stevens-Lapsley JE, Balter JE, Wolfe P, et al. Early neuromuscular electrical stimulation to improve quadriceps muscle strength after total knee arthroplasty: a randomized controlled trial. Phys Ther, 2012, 92(2): 210-226.