Yeoh David, Nicolaou Nick, Goddard Richard, Willmott Henry, Miles Kim, East Debra, Hinves Barry, Shepperd John, Butler-Manuel Adrian
Conquest Hospital, East Sussex Hospital Trust Hastings, United Kingdom.
Knee. 2012 Aug;19(4):329-31. doi: 10.1016/j.knee.2011.05.009. Epub 2011 Jun 23.
A reduced range of motion post total knee replacement (TKR) is a recognised problem. Manipulation under anaesthesia (MUA) is commonly performed in the stiff post-operative TKR. Long-term results are variable in the literature. We retrospectively reviewed, prospectively collected data on 48 patients followed up since 1996 from one centre, over an average of 7.5 years, (range 1 to 10 years) and report on the long-term results. During the study period 2.3% of TKRs underwent MUA. The mean time to MUA post TKR was 12.3 weeks (range 3 to 48). Pre MUA, the mean flexion was 53°. The mean immediate passive flexion post MUA was 97°, an improvement of 44° (Range 10° to 90°, p<0.05). By 1year, the mean flexion was 87°, an improvement of 34°, (range -15° to 70°, p<0.05). At 10 years the mean flexion was 86°, (range 55° to 100°, p<0.05). We found no difference in the gain in range of motion (ROM) between knees manipulated before or after 12 weeks. Additionally, the gain was no different in stiff knees with a pre TKR ROM <90°, compared to a pre TKR ROM >90°. There were no complications as a result of MUA. However, one patient was eventually revised at 2 years secondary to low grade infection. Our findings show that MUA is a safe and effective method at improving the ROM in a stiff post-operative TKR. The improvement is maintained in the long term irrespective of time to MUA and range of motion pre TKR.
全膝关节置换术（TKR）后活动范围减小是一个公认的问题。麻醉下手法松解（MUA）常用于TKR术后僵硬的情况。文献中关于其长期效果的报道各不相同。我们对自1996年起来自一个中心的48例患者进行了回顾性研究，并前瞻性收集了数据，平均随访7.5年（范围1至10年），并报告长期结果。在研究期间，2.3%的TKR患者接受了MUA。TKR后进行MUA的平均时间为12.3周（范围3至48周）。MUA前，平均屈曲角度为53°。MUA后即时被动屈曲平均角度为97°，改善了44°（范围10°至90°，p<0.05）。到1年时，平均屈曲角度为87°，改善了34°（范围-15°至70°，p<0.05）。在10年时，平均屈曲角度为86°（范围55°至100°，p<0.05）。我们发现，在12周之前或之后进行手法松解的膝关节，其活动范围（ROM）的增加没有差异。此外，与TKR术前ROM>90°的僵硬膝关节相比，TKR术前ROM<90°的僵硬膝关节在ROM增加方面没有差异。MUA没有导致并发症。然而，有1例患者在2年后因低度感染最终进行了翻修。我们的研究结果表明，MUA是改善TKR术后僵硬膝关节ROM的一种安全有效的方法。无论进行MUA的时间和TKR术前的活动范围如何，这种改善在长期内都能维持。
