Department of Orthopaedic Surgery, the Second Xiangya Hospital, Central South University, Changsha, China.
Orthop Surg. 2021 Jun;13(4):1284-1289. doi: 10.1111/os.12950. Epub 2021 May 6.
To investigate the clinical outcomes and the affecting factors of Judet's quadricepsplasty on the stiffness of post-traumatic knee flexion.
A retrospective survey was analyzed from June 2015 to October 2018. A total of 15 patients (eight males, seven females; mean age, 48.27 years) with extension contracture of the knee were treated by Judet's quadricepsplasty. All cases were injuries induced by fracture trauma. The mean interval between the initial procedure and quadricepsplasty was 56.2 months (range, 13-276 months). The knee range of motion (ROM) was assessed with a goniometer. The results of the procedure were analyzed by measuring the degrees of flexion of the operated knees at different time points (before, immediately after, and late postoperatively). We evaluated Hospital for Special Surgery (HSS) score, Judet's criteria, change in the degree of knee flexion, and complications.
All patients were followed up for 14 to 47 months, with an average of 31.53 months. The degree of flexion increased from 23.33° (range, 10°-50°) preoperatively to 107.33° (range, 100°-125°) intraoperatively, followed by a slight fall in the range of flexion in the late postoperative period, which reached an average of 95.33° (range, 60°-115°) in the last follow-up. The knee joint function was assessed according to the Judet's criteria, eight cases (53.33%) achieved excellent results, six (40%) good, one (6.67%) fair, and zero (0.00%) poor results at final follow-up. The long-term excellent and good rate was 93.33%. The range of flexion of the knee during operation and at the last time of follow-up was better than that before surgery (P < 0.001). The final flexion was significantly lower than that measured at immediate postoperative (P < 0.001). The mean postoperative HSS score for the entire group was 93.73 (range, 89-96). Fifteen excellent results were obtained according to the HSS knee score. Skin infection was seen in one patient (6.67%). There were no complications such as deep sepsis, intraoperative rupture of the quadriceps tendon, fracture of the lateral femoral condyle, skin dehiscence.
Judet quadricepsplasty is an effective method to treat knee extension contracture and improve knee range of motion (ROM). It should be performed by an experienced orthopaedic surgeon and followed by physiotherapy with continuous passive motion (CPM). The knee ROM obtained with the surgery has an excellent long-term effect.
探讨 Judet 四头肌成形术治疗创伤后膝关节伸直挛缩的临床效果及其影响因素。
回顾性分析 2015 年 6 月至 2018 年 10 月收治的 15 例（8 例男性，7 例女性；平均年龄 48.27 岁）创伤后膝关节伸直挛缩患者的临床资料，均为骨折创伤所致。初次手术至四头肌成形术的平均间隔时间为 56.2 个月（范围 13~276 个月）。采用量角器评估膝关节活动度（ROM）。测量手术膝关节在不同时间点（术前、即刻、术后晚期）的屈曲度，分析手术结果。评估膝关节美国特种外科医院（HSS）评分、Judet 标准、膝关节屈曲度变化及并发症。
所有患者均获得随访，随访时间 1447 个月，平均 31.53 个月。术前膝关节屈曲度为 23.33°（范围 10°50°），术中增加至 107.33°（范围 100°125°），术后晚期膝关节屈曲度略有下降，末次随访时平均为 95.33°（范围 60°115°）。根据 Judet 标准评估膝关节功能，末次随访时 8 例（53.33%）为优，6 例（40.00%）为良，1 例（6.67%）为可，无差。优良率为 93.33%。膝关节术中及末次随访时的屈曲度均优于术前（P<0.001），末次随访时的屈曲度明显低于术后即刻（P<0.001）。全组患者术后 HSS 评分平均为 93.73 分（范围 89~96 分），根据 HSS 膝关节评分，15 例获优。1 例（6.67%）发生皮肤感染。无深部感染、术中股四头肌肌腱断裂、外侧股骨髁骨折、皮肤裂开等并发症。
Judet 四头肌成形术是治疗膝关节伸直挛缩、改善膝关节活动度（ROM）的有效方法，应由经验丰富的骨科医生施行，术后进行持续被动运动（CPM）的物理治疗。手术获得的膝关节 ROM 具有优异的长期效果。
