Scott Richard D
Harvard Medical School, 125 Parker Hill, Boston, MA 02120, USA.
Orthopedics. 2009 Sep;32(9). doi: 10.3928/01477447-20090728-30.
Multiple factors may lead to stiffness after total knee arthroplasty (TKA), including patient diagnosis, preoperative range of motion (ROM), prosthetic geometry used, surgical technique, intraoperative ROM after capsular closure, postoperative rehabilitation, and wound healing factors. An ipsilateral arthritic hip can also inhibit postoperative recovery and lead to knee stiffness. Exposure of the ankylosed knee can be difficult. One must take care to avoid excessive stress on the patellar tendon insertion leading to patellar tendon avulsion. The 2 most common methods to facilitate exposure are a proximal release or a tibial tubercle osteotomy. When patients fail to achieve satisfactory ROM after TKA, manipulation under anesthesia is considered. It is usually performed approximately 6 weeks postoperatively. The best indicator of each patient's potential is his or her intraoperative flexion against gravity with the capsule closed at the end of the procedure.
多种因素可能导致全膝关节置换术（TKA）后出现僵硬，包括患者诊断、术前活动范围（ROM）、所用假体的几何形状、手术技术、关节囊闭合后的术中ROM、术后康复以及伤口愈合因素。同侧患关节炎的髋关节也会抑制术后恢复并导致膝关节僵硬。暴露强直的膝关节可能很困难。必须注意避免髌腱止点承受过大应力，以免导致髌腱撕脱。两种最常用的便于暴露的方法是近端松解或胫骨结节截骨术。当患者在TKA后未能获得满意的ROM时，可考虑在麻醉下进行手法操作。通常在术后约6周进行。每个患者潜力的最佳指标是其在手术结束时关节囊闭合状态下术中对抗重力的屈曲情况。
