Ebrahimzadeh Mohammad H, Birjandi-Nejad Ali, Ghorbani Said, Khorasani Mohammad Reza
Department of Orthopedic Surgery, Orthopedic Research Center, Mashad University of Medical Sciences, Mashad, Iran.
J Trauma. 2010 Jun;68(6):1471-5. doi: 10.1097/TA.0b013e3181bdcdec.
The lack of knee flexion is an increasingly recognized complication of femoral and periarticular knee fractures. This is a significant challenge for both surgeon and patients.
This article reports the clinical outcomes of 40 knees in 40 patients who underwent a modified Thompson quadricepsplasty. They were 36 men and 4 women. We performed a modified Thompson quadricepsplasty for all patients without excision of vastus intermedius even in scarred cases. The definitive flexion gain was classified recording to Judet criteria; excellent defined as >100 degrees, good when >80 degrees and <99 degrees, fair when >50 degrees and <79 degrees, and poor when <50 degrees.
Patients were operated on average 6.9 months +/- 3.6 months (range, 4-24 months) after first initial surgery. Average follow-up was 17.5 months (range, 12-24 months). According to Judet criteria, 9 patients (22.5%) achieved excellent, 27 patients (67.5%) good, 2 patients (5%) fair, and 2 patients (5%) poor. Final average flexion arc improvement was 65 degrees +/- 25.99 degrees with a range between 5 degrees and 100 degrees. Our complications included two cases (5%) of superficial infection and one case (2.5%) with patellar fracture. In patients who had preoperative extension lag, we did not achieve a significant improvement of the extension lag (p = 0.062).
Modified Thompson quadricepsplasty is a promising procedure with satisfactory results. It provides significantly results if it is performed earlier and in more severe extension contracture.
膝关节屈曲受限是股骨及膝关节周围骨折越来越常见的并发症。这对医生和患者来说都是一项重大挑战。
本文报告了40例接受改良汤普森股四头肌成形术患者的40个膝关节的临床结果。其中男性36例，女性4例。我们对所有患者均进行了改良汤普森股四头肌成形术，即使在有瘢痕的病例中也未切除股中间肌。最终的屈曲增加情况根据朱代标准进行分类记录；优定义为>100度，良为>80度且<99度，中为>50度且<79度，差为<50度。
患者在首次初次手术后平均6.9个月±3.6个月（范围4 - 24个月）接受手术。平均随访时间为17.5个月（范围12 - 24个月）。根据朱代标准，9例患者（22.5%）为优，27例患者（67.5%）为良，2例患者（5%）为中，2例患者（5%）为差。最终平均屈曲弧改善为65度±25.99度，范围在5度至100度之间。我们的并发症包括2例（5%）表浅感染和1例（2.5%）髌骨骨折。在术前存在伸直滞后的患者中，我们未实现伸直滞后的显著改善（p = 0.062）。
改良汤普森股四头肌成形术是一种有前景的手术方法，结果令人满意。如果手术时机更早且用于更严重的伸直挛缩，能取得显著效果。
