Mont Michael A, Seyler Thorsten M, Marulanda German A, Delanois Ronald E, Bhave Anil
Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA.
Clin Orthop Relat Res. 2006 May;446:193-200. doi: 10.1097/01.blo.0000214419.36959.8c.
Treating patients who have arthrofibrotic or stiff knees after total knee arthroplasty can be difficult. Treatment with arthroscopic débridement, arthrolysis of adhesions with polyethylene spacer exchange, or complete revision arthroplasty often has led to less than optimal range of motion and functional outcomes. We used a combination of surgical arthrolysis and an intensive postoperative rehabilitation protocol, including functional bracing, to treat this condition. We then retrospectively reviewed 18 knees in 17 patients who had stiff knees after total knee arthroplasty with no other detectable clinical or radiographic abnormalities, at a mean followup of 30 months. Seventeen knees (94%) had gains in knee range of motion with a mean increased range of motion of 31 degrees. Although 16 of 17 patients had clinical improvement and were satisfied with the procedure, only (2/3) of the patients (12 of 18 patients) had excellent or good Knee Society objective scores. This combined surgical and rehabilitation method can lead to an increased range of motion. All patients improved clinically, but good functional results were less predictable. The authors think treatment of these difficult knees should be aimed at soft tissue operative releases supplemented by an intensive rehabilitation protocol.
Therapeutic study, level IV (prospective study). See Guidelines for Authors for a complete description of levels of evidence.
治疗全膝关节置换术后出现关节纤维化或膝关节僵硬的患者可能具有挑战性。采用关节镜清创、使用聚乙烯间隔物置换进行粘连松解术或进行全翻修关节成形术治疗，往往导致活动范围和功能结果不尽人意。我们采用手术松解术与强化术后康复方案相结合的方法，包括使用功能性支具，来治疗这种情况。然后，我们回顾性分析了17例患者的18个膝关节，这些患者在全膝关节置换术后出现膝关节僵硬，且无其他可检测到的临床或影像学异常，平均随访30个月。17个膝关节（94%）的膝关节活动范围增加，平均增加31度。虽然17例患者中有16例临床症状改善并对手术满意，但只有（2/3）的患者（18例患者中的12例）获得了优秀或良好的膝关节协会客观评分。这种手术与康复相结合的方法可增加活动范围。所有患者临床症状均有改善，但良好的功能结果较难预测。作者认为，治疗这些难治性膝关节应旨在进行软组织手术松解，并辅以强化康复方案。
治疗性研究，IV级（前瞻性研究）。有关证据水平的完整描述，请参阅《作者指南》。
