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膝关节纤维性关节病的临床表现与治疗:病例报告

Presentation and management of arthrofibrosis of the knee: A case report.

作者信息

Scholtes Sara A, Khoo-Summers Lynnette, Damico Katherine J

机构信息

a Department of Physical Therapy and Athletic Training , Saint Louis University , Saint Louis , MO , USA.

b Program in Physical Therapy and Department of Orthopaedic Surgery , Washington University School of Medicine , St. Louis , MO , USA.

出版信息

Physiother Theory Pract. 2017 Oct;33(10):815-824. doi: 10.1080/09593985.2017.1346027. Epub 2017 Jul 17.

Abstract

STUDY DESIGN

Case report.

BACKGROUND

Arthrofibrosis is a debilitating condition that results in pain, decreased range of motion, and decreased function. Although surgical management of arthrofibrosis has been well described in the literature, rehabilitation of the arthrofibrotic knee is less well described.

CASE DESCRIPTION

A 28-year-old female presented with swelling, pain, and decreased strength, range of motion, patellar mobility, and function following an exploratory arthroscopy of her left knee. After failed conservative management, the patient underwent two additional surgeries to remove scar tissue. Following each surgery, the emphasis was on decreasing inflammation and maintaining patellar mobility while increasing joint range of motion and strength. Therapy progression was determined by the presence or absence of inflammatory signs. The second scar tissue removal surgery resulted in a femoral neuropathy that further complicated the rehabilitation process.

OUTCOMES

At 3-year follow-up, the patient continued to present with decreased range of motion and strength compared to the uninvolved limb, but had returned to a modified running program and reported pain no longer limited her ability to participate in activities of daily living.

DISCUSSION

This case report highlights the importance of recognizing that arthrofibrosis may result following a minor knee surgery and with minimal range of motion loss. Additional complications also may result during arthrofibrosis treatment. Progressing rehabilitation based on the inflammatory response may decrease the likelihood of additional scar tissue formation and potentially improve the outcome for the patient.

摘要

研究设计

病例报告。

背景

关节纤维化是一种使人衰弱的病症,会导致疼痛、活动范围减小以及功能下降。尽管关节纤维化的手术治疗在文献中已有详尽描述,但关节纤维化膝关节的康复治疗描述较少。

病例描述

一名28岁女性在左膝进行探查性关节镜检查后,出现肿胀、疼痛,力量、活动范围、髌骨活动度及功能均下降。保守治疗失败后,患者又接受了两次手术以清除瘢痕组织。每次手术后,重点都是减轻炎症、保持髌骨活动度,同时增加关节活动范围和力量。治疗进程根据是否存在炎症体征来确定。第二次瘢痕组织清除手术导致股神经病变,使康复过程更加复杂。

结果

在3年的随访中,与未受累肢体相比,患者的活动范围和力量仍然下降,但已恢复到改良的跑步计划,并且报告疼痛不再限制她参与日常生活活动的能力。

讨论

本病例报告强调了认识到关节纤维化可能在轻微膝关节手术后出现且活动范围损失最小的重要性。关节纤维化治疗期间也可能出现其他并发症。根据炎症反应推进康复治疗可能会降低额外瘢痕组织形成的可能性,并有可能改善患者的预后。

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