發(fā)布時間：2019-01-20 11:28

【摘要】：目的：關(guān)節(jié)鏡下行粘連松解術(shù)治療膝關(guān)節(jié)僵硬的臨床觀察。方法：2013年3月~2014年6月在我科行關(guān)節(jié)鏡下粘連松解術(shù)治療的膝關(guān)節(jié)僵硬患者。有26例,其中因股骨下段骨折9例,髕骨骨折3例,髕骨、股骨下段雙骨折1例,脛骨上段骨折1例,脛骨髁間隆突骨折2例,股骨下段、脛骨雙骨折2例,關(guān)節(jié)鏡下前交叉韌帶重建術(shù)后1例,前、后交叉韌帶開放重建術(shù)后1例,前后交叉韌帶合并內(nèi)側(cè)副韌帶關(guān)節(jié)鏡下重建術(shù)后3例,前后交叉韌帶重建合并股骨髁骨折關(guān)節(jié)鏡下術(shù)后1例,軟組織裂傷術(shù)后2例。所有26例患者均在關(guān)節(jié)鏡下行粘連松解術(shù)治療膝關(guān)節(jié)僵硬,術(shù)中松解髕上囊、股中間肌及髁間窩的粘連,并予以手法推拿松解,術(shù)中徹底止血。術(shù)后予以冰敷、股四頭肌肌力練習(xí)及抗炎消腫等康復(fù)治療。通過手術(shù)前后活動范圍、VAS及HSS評分的比較來評估療效。結(jié)果：本組26例患者均獲得隨訪,隨訪至術(shù)后6個月。術(shù)前VAS評分為(1.46±2.04),隨訪結(jié)束時的VAS評分為(0.38±0.80),術(shù)后的疼痛較術(shù)前減輕(t=3.89,P0.001)。術(shù)前HSS評分為(58.08±12.07),隨訪結(jié)束時的HSS評分為(71.96±8.98),術(shù)后的膝關(guān)節(jié)功能較術(shù)前明顯改善(t=-14.77,P0.001)。其中膝關(guān)節(jié)屈曲角度平均為(106.54±12.87)。,較術(shù)前增加57°,與術(shù)前相比有統(tǒng)計學(xué)差異(t=-10.72,P0.001)。1例發(fā)生骨化性肌炎,無術(shù)后切口感染、皮膚壞死、髕腱斷裂等并發(fā)癥。結(jié)論：關(guān)節(jié)鏡手術(shù)治療膝關(guān)節(jié)僵硬的方法具有創(chuàng)傷小,并發(fā)癥少,臨床效果好等優(yōu)點,手術(shù)較安全。
[Abstract]:Objective: to observe the clinical effect of arthroscopic adhesion release in the treatment of knee joint stiffness. Methods: from March 2013 to June 2014, patients with knee joint stiffness were treated with arthroscopic adhesion release. There were 26 cases, including 9 cases of distal femur fracture, 3 cases of patellar fracture, 1 case of double fracture of distal femur, 1 case of fracture of upper tibia, 2 cases of fracture of intercondylar process of tibia, 2 cases of double fracture of lower femur and tibia. Arthroscopic anterior cruciate ligament reconstruction in 1 case, anterior and posterior cruciate ligament open reconstruction in 1 case, anterior cruciate ligament with medial collateral ligament arthroscopic reconstruction in 3 cases. Anterior cruciate ligament reconstruction with femoral condylar fracture was performed in 1 case and soft tissue laceration in 2 cases. All the 26 cases were treated with arthroscopic adhesion release. The adhesion of the superior patellar sac, medius femoris and intercondylar fossa was relieved during the operation. Postoperative ice compress, quadriceps femoris muscle strength exercise and anti-inflammatory and swelling rehabilitation treatment. The efficacy was evaluated by comparing the range of activities, VAS and HSS scores before and after surgery. Results: all 26 patients were followed up until 6 months after operation. The preoperative VAS score was (1.46 鹵2.04) and the VAS score at the end of follow-up was (0.38 鹵0.80). The preoperative HSS score was (58.08 鹵12.07) and the HSS score at the end of follow-up was (71.96 鹵8.98). The average flexion angle of knee joint was (106.54 鹵12.87).,), which was 57 擄higher than that before operation. Patellar tendon rupture and other complications. Conclusion: arthroscopic treatment of knee joint stiffness has the advantages of less trauma, less complications and better clinical effect.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.4

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