Cates Hal E, Schmidt John M
Research Department, Tennessee Orthopaedic Clinics, 9430 Parkwest Blvd, Ste 130, Knoxville, TN 37923, USA.
Orthopedics. 2009 Jun;32(6):398. doi: 10.3928/01477447-20090511-10.
Clinic records of 37 manipulations in 767 consecutive primary total knee arthroplasties (TKAs) were analyzed to identify any predictors of manipulation outcome. Factors studied were sex, age, body mass index, tibiofemoral alignment, surgical history, smoking history, range of motion before TKA and manipulation, intraoperative lateral release, implant design and manufacturer, and manipulation interval. Measures of outcome were gains in extension and flexion from manipulation and range of motion at 1-year follow-up. Patients gained an average of 4 degrees of extension and 22 degrees of flexion after manipulation, resulting in average extension of 1 degree and average flexion of 105 degrees at 1-year follow-up. Restored flexion was similar to that measured preoperatively. Manipulation was most effective in patients manipulated within 8 weeks, with full extension and <90 degrees of flexion prior to manipulation, and those receiving a lateral release during arthroplasty. Potential for benefit from manipulation appears to be reduced in patients with large flexion contractures but with adequate flexion. Patients with flexion contractures regained only approximately 80% of the extension they lacked before manipulation. Only 12 of 18 patients (67%) with flexion contractures regained full extension. Manipulation is successful at regaining flexion and restoring function for patients of all levels of flexion deficiency. At least 90 degrees of flexion was regained in 20 of 23 patients (87%) who lacked it at manipulation.
对767例连续初次全膝关节置换术（TKA）中的37例手法操作的临床记录进行分析，以确定手法操作结果的任何预测因素。研究的因素包括性别、年龄、体重指数、胫股对线、手术史、吸烟史、TKA和手法操作前的活动范围、术中外侧松解、植入物设计和制造商以及手法操作间隔。结果的衡量指标是手法操作后伸直和屈曲的增加以及1年随访时的活动范围。手法操作后患者平均伸直增加4度，屈曲增加22度，1年随访时平均伸直为1度，平均屈曲为105度。恢复的屈曲与术前测量的相似。手法操作在8周内接受手法操作、手法操作前完全伸直且屈曲<90度以及在关节置换术中接受外侧松解的患者中最有效。对于有大的屈曲挛缩但屈曲充分的患者，手法操作获益的可能性似乎降低。有屈曲挛缩的患者仅恢复了他们在手法操作前缺乏的伸直的约80%。18例有屈曲挛缩的患者中只有12例（67%）恢复了完全伸直。手法操作对于所有屈曲不足程度的患者在恢复屈曲和恢复功能方面都是成功的。23例手法操作时缺乏至少90度屈曲的患者中有20例（87%）恢复了至少90度的屈曲。
