Department of Orthopaedics, The Mount Sinai Hospital, New York, NY, 10029, USA.
Clin Orthop Relat Res. 2010 Apr;468(4):1096-106. doi: 10.1007/s11999-010-1230-y. Epub 2010 Jan 20.
Multiple modalities have been used to treat the stiff TKA, including manipulation under anesthesia (MUA), arthroscopy, and open arthrolysis.
QUESTIONS/PURPOSES: We reviewed the literature to address three questions: (1) How many degrees of ROM will a stiff TKA gain after MUA, arthroscopy, and open arthrolysis? (2) Does the timing of each procedure influence this gain in ROM? (3) What is the number of clinically important complications for each procedure?
We performed a PubMed search of English language articles from 1966 to 2008 and identified 20 articles, mostly Level IV studies.
For patients who have arthrofibrosis after TKA, the gains in ROM after MUA and arthroscopy (with or without MUA) are similar. Open arthrolysis seems to have inferior gains in ROM. MUA is more successful in increasing ROM when performed early but still may be effective when performed late. Arthroscopy combined with MUA still is useful 1 year after the index TKA. The numbers of clinically important complications after MUA and arthroscopy (with or without MUA) are similar.
Stiffness after TKA is a common problem that can be improved with MUA and/or arthroscopic lysis of adhesions with few complications. The low quality of available literature makes it difficult to develop treatment protocols.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
多种方法已被用于治疗僵硬的 TKA，包括麻醉下手法松解（MUA）、关节镜和开放松解术。
问题/目的：我们回顾了文献，以回答三个问题：（1）MUA、关节镜和开放松解术后僵硬的 TKA 会增加多少活动度？（2）每个手术的时机是否会影响 ROM 的增加？（3）每个手术的临床重要并发症的数量是多少？
我们对 1966 年至 2008 年的英文文献进行了 PubMed 搜索，并确定了 20 篇文章，主要是 IV 级研究。
对于 TKA 后发生关节纤维强直的患者，MUA 和关节镜（有或没有 MUA）后 ROM 的增加相似。开放松解术似乎 ROM 的增加效果较差。早期进行 MUA 可更成功地增加 ROM，但晚期进行 MUA 仍可能有效。关节镜联合 MUA 在 TKA 后 1 年仍然有效。MUA 和关节镜（有或没有 MUA）后的临床重要并发症数量相似。
TKA 后僵硬是一个常见的问题，可以通过 MUA 和/或关节镜下松解粘连来改善，且并发症少。现有文献质量较低，难以制定治疗方案。
IV 级，治疗性研究。有关证据水平的完整描述，请参见作者指南。
