Tanzer M, Miller J
Department of Orthopaedic Surgery, Montreal General Hospital, McGill University, Canada.
Clin Orthop Relat Res. 1989 Nov(248):129-34.
A prospective study was carried out to document the natural history of flexion contractures of the knee after total knee arthroplasty (TKA). Thirty-five knees in 33 patients with TKA were followed for a mean duration of 55 weeks. In no case did the surgical procedure include excessive bony resection in order to correct a flexion contracture. Standard goniometric measurements were used to determine the knee flexion contractures preoperatively and postoperatively while the patient was anesthetized and at each successive follow-up visit. All preoperative and postoperative flexion contractures were less than 30 degrees. The mean fixed flexion deformity of the entire group preoperatively was 12.9 degrees; immediately postoperatively, 14.8 degrees; and at final follow-up, 2.9 degrees. No difference was found in the amount of flexion contracture present at final follow-up evaluation with respect to age or gender. The impression that fixed flexion contractures must be corrected at the time of arthroplasty has led to the intraoperative removal of excess bone from the distal femur and/or proximal tibia. The present findings indicate that knee flexion contractures can significantly improve after TKA. There appears to be little, if any indication for excessive removal of bone in an attempt to achieve intraoperative correction.
进行了一项前瞻性研究，以记录全膝关节置换术（TKA）后膝关节屈曲挛缩的自然病程。对33例接受TKA的患者的35个膝关节进行了平均55周的随访。在任何情况下，手术过程均未包括为纠正屈曲挛缩而进行的过度骨切除。采用标准测角法在患者麻醉时以及每次连续随访时测定术前和术后的膝关节屈曲挛缩情况。所有术前和术后的屈曲挛缩均小于30度。整个组术前平均固定屈曲畸形为12.9度；术后即刻为14.8度；最终随访时为2.9度。在最终随访评估中，未发现屈曲挛缩程度在年龄或性别方面存在差异。认为在关节置换时必须纠正固定屈曲挛缩的观念导致术中从股骨远端和/或胫骨近端去除多余骨质。目前的研究结果表明，TKA后膝关节屈曲挛缩可显著改善。试图在术中进行纠正而过度去除骨质似乎几乎没有任何指征。
