Giunti A, Vicenzi G, Luppino D, Cefalì F
Ital J Orthop Traumatol. 1981 Aug;7(2):149-57.
After a brief historical review of the surgical treatment of long-established stiffness of the knee, and a discussion of the related indications, the authors describe the surgical technique used in their Division of the Rizzoli Institute. Basically, we use Judet's arthromyolysis, but we often perform, as an initial stage, medial arthrolysis without particular concern for the medial collateral ligament. Our results prove that this does not cause instability. Twenty-seven of the thirty knees in our series presented as sequelae of fractures of the femur where there had been complications, or in which immobilisation had been unduly prolonged. Analysis of the results shows that: a) average pre-operative flexion of 25 degrees was increased to 95 degrees, without sacrificing stability; b) section of the collateral ligaments does not cause long term instability; c) proximal disinsertion of the rectus femoris tendon may lead to loss of active extension, although this was always well tolerated; d) persisting pain is always due to the development of arthrosis; e) The age of the patient, the duration and aetiology of the stiffness have no effect on the results. The complications consisted of two cases of skin necrosis and one of infection, but these were quickly resolved and did not affect the end results.
在对膝关节长期僵硬的手术治疗进行简要的历史回顾并讨论相关适应证后，作者描述了他们在里佐利研究所科室所采用的手术技术。基本上，我们采用朱代的关节松解术，但作为初始阶段，我们经常进行内侧关节松解，而不太关注内侧副韧带。我们的结果证明这不会导致不稳定。我们系列中的30个膝关节中有27个表现为股骨骨折的后遗症，这些骨折曾出现并发症，或者固定时间过长。结果分析表明：a）平均术前屈曲25度增加到95度，且未牺牲稳定性；b）切断侧副韧带不会导致长期不稳定；c）股直肌腱近端止点离断可能导致主动伸直丧失，尽管这种情况总能很好地耐受；d）持续疼痛总是由于关节炎的发展；e）患者年龄、僵硬的持续时间和病因对结果没有影响。并发症包括2例皮肤坏死和1例感染，但这些很快得到解决，并未影响最终结果。
