麻醉下手法治疗：膝关节创伤后关节纤维性强直的一种安全有效的治疗方法。
Manipulation Under Anesthesia: A Safe and Effective Treatment for Posttraumatic Arthrofibrosis of the Knee.
作者信息
Sassoon Adam A, Adigweme Obinna O, Langford Joshua, Koval Kenneth J, Haidukewych George J
机构信息
*Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA; and †Department of Orthopaedic Surgery, Orlando Regional Medical Center, Orlando, FL.
出版信息
J Orthop Trauma. 2015 Dec;29(12):e464-8. doi: 10.1097/BOT.0000000000000395.
OBJECTIVES
This study investigates the results of closed manipulations performed under anesthesia (MUA) to evaluate whether it is an effective means to treat posttraumatic knee arthrofibrosis.
DESIGN
Retrospective review.
SETTING
Level I trauma center.
PATIENTS/PARTICIPANTS: Twenty-two patients with a mean age of 40 underwent closed MUA for posttraumatic knee arthrofibrosis. Injuries included fractures of the femur, tibia, and patella as well as ligamentous injuries and traumatic arthrotomies. The mean time from treatment to manipulation was 90 days. Mean follow-up after manipulation was 7 months.
INTERVENTION
Closed knee MUA.
OUTCOME MEASUREMENTS
Improvement of knee range of motion (ROM) arc was the primary outcome. Patient demographics were correlated with manipulation success using a 2-sample t test. A delay in manipulation of 90 days or greater was also evaluated in this fashion with regard to its role in predicting the benefit of MUA.
RESULTS
The mean premanipulation ROM arc was 59 ± 25 degrees. The mean intraoperative arc of motion, achieved at the time of the manipulation was 123 ± 14 degrees. No complications occurred during the MUA procedure. At the most recent follow-up, the mean ROM arc was 110 ± 19 degrees. Tobacco use, associated injuries, elevated body mass index, open fracture, and advanced age did not impact manipulation efficacy. Additionally, manipulations performed 90 days or more after surgical treatment provided a benefit equaling those performed more acutely (P = 0.12).
DISCUSSION
MUA is a safe and effective method to increase knee ROM in the setting of posttraumatic arthrofibrosis. Improvement in ROM was noted in all patients. A 90-day window between fracture fixation and manipulation did not impact ROM at final follow-up and may prevent fracture displacement during the MUA.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
目的
本研究调查在麻醉下进行闭合手法治疗（MUA）的结果，以评估其是否为治疗创伤后膝关节纤维性关节僵直的有效方法。
设计
回顾性研究。
地点
一级创伤中心。
患者/参与者：22例平均年龄40岁的患者因创伤后膝关节纤维性关节僵直接受了闭合MUA治疗。损伤包括股骨、胫骨和髌骨骨折以及韧带损伤和开放性关节切开术。从治疗到手法治疗的平均时间为90天。手法治疗后的平均随访时间为7个月。
干预措施
膝关节闭合MUA。
观察指标
膝关节活动范围（ROM）弧度的改善是主要观察指标。使用双样本t检验将患者人口统计学特征与手法治疗成功率相关联。还以这种方式评估了90天或更长时间的手法治疗延迟在预测MUA益处方面的作用。
结果
手法治疗前ROM弧度的平均值为59±25度。手法治疗时术中活动弧度的平均值为123±14度。MUA过程中未发生并发症。在最近一次随访时，ROM弧度的平均值为110±19度。吸烟、合并损伤、体重指数升高、开放性骨折和高龄均不影响手法治疗效果。此外，手术治疗90天或更长时间后进行的手法治疗提供的益处与更早进行的手法治疗相当（P = 0.12）。
讨论
MUA是增加创伤后关节纤维性关节僵直患者膝关节ROM的一种安全有效的方法。所有患者的ROM均有改善。骨折固定与手法治疗之间90天的时间间隔在最终随访时不影响ROM，并且可能防止MUA期间骨折移位。
证据水平
治疗性四级。有关证据水平的完整描述，请参阅作者指南。
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