Djian P, Christel P, Witvoet J
Service d'Orthopédie, Hôpital Lariboisière, 1, rue Ambroise-Paré, 75010 Paris.
Rev Chir Orthop Reparatrice Appar Mot. 2002 Apr;88(2):163-7.
Overall, the results of total knee replacement surgery are quite excellent, both with regard to pain and range of motion. Pain relief is obtained in more than 95% of the cases and more than 90% of the patients are able to bend their knee over 90 degrees. Nevertheless, in a small number of cases, stiffness can be an impairment.
Between 1992 and 1998, six arthroscopic releases were performed on six patients who had undergone total knee replacement. The six patients suffered from unacceptable stiffness. The average age of the patients was 68.5 years, and the time elapsed from implantation to arthroscopy averaged 24 months (6 months to 6 years). Average follow-up was 19 months (6 to 96 months). The six stiff knees were treated with arthroscopic debridement of fibrous tissue around the patella and quadriceps tendon (to improve extension) and by arthroscopic division of the medial and lateral retinacula (to address flexion). A gentle manipulation was carried out following lysis of adhesions, using a slight pressure on the tubercle to avoid fractures and disruptions of the extensor mechanisms. Postoperatively, immediate physical therapy was performed including continuous passive motion and active muscular contraction. Early weight bearing was allowed.
The average flexion contracture decreased from 9 degrees prior to arthroscopy to 2.5 degrees at last follow-up. Average flexion increased from 70 to 100 degrees. Maximal improvement was obtained at three months.
Results were found to be quite good, with a final knee score of 93 and a function score of 92 (following International Knee Society scoring).
Arthroscopic release following total knee replacement complicated by joint stiffness provides a satisfactory increase in range of motion.
总体而言，全膝关节置换手术在疼痛和活动范围方面的结果相当出色。超过95%的病例疼痛得到缓解，超过90%的患者能够将膝关节弯曲超过90度。然而，在少数情况下，僵硬可能会成为一种功能障碍。
1992年至1998年间，对6例接受全膝关节置换术的患者进行了6次关节镜下松解术。这6例患者存在难以接受的膝关节僵硬。患者的平均年龄为68.5岁，从植入到关节镜检查的平均时间为24个月（6个月至6年）。平均随访时间为19个月（6至96个月）。对这6个僵硬的膝关节进行关节镜下清理髌骨和股四头肌腱周围的纤维组织（以改善伸直）以及关节镜下切断内外侧支持带（以解决屈曲问题）。在粘连松解后进行轻柔手法操作，对胫骨结节施加轻微压力以避免伸肌机制的骨折和断裂。术后立即进行物理治疗，包括持续被动活动和主动肌肉收缩。允许早期负重。
平均屈曲挛缩从关节镜检查前的9度降至最后随访时的2.5度。平均屈曲度从70度增加到100度。在三个月时获得最大改善。
结果相当良好，最终膝关节评分为93分，功能评分为92分（根据国际膝关节协会评分）。
全膝关节置换术后并发关节僵硬时，关节镜下松解可使活动范围得到令人满意的增加。
