Lobenhoffer P, Gögüs A, Gerich T
Unfallchirurgische Klinik, Medizinische Hochschule Hannover.
Orthopade. 1993 Nov;22(6):392-8.
The development of arthrofibrosis in a serious complication of knee ligament injury or knee ligament surgery. The fibrosis is caused by a pathologic quantity or quality of collagen fiber formation in the knee or in the capsular structures, causing irreversible loss of range of motion, restricted patellar motion and finally patella baja with frank osteoarthritis of the patella. The major factors inducing fibrosis are notch impingement, development of a cyclops on an anterior cruciate ligament graft, scarring of the fat pad and the retinacula and adhesions in the recesses of the joint. Our therapeutic concept includes aggressive physiotherapy and an early arthroscopic procedure if conservative measures fail. A posterior capsulotomy is performed from a posteromedial arthrotomy in cases with flexion contracture persisting over a number of years. In 16 patients reviewed 17 months after arthroscopic treatment of arthrofibrosis the average improvement in range of motion was 13 degrees for extension and 25 degrees for flexion. A further 7 patients with chronic flexion contractures persisting for 1 year or more were treated with a posterior capsulotomy and reviewed 18 months after surgery. The average gain for extension was 15 degrees in these patients at follow-up.
关节纤维化是膝关节韧带损伤或膝关节韧带手术后的一种严重并发症。这种纤维化是由膝关节或关节囊结构中胶原纤维形成的病理性数量或质量引起的，导致不可逆转的活动范围丧失、髌骨活动受限，最终导致髌骨低位并伴有明显的髌骨骨关节炎。引发纤维化的主要因素包括切迹撞击、前交叉韧带移植物上形成“独眼巨人”样病变、脂肪垫和支持带瘢痕形成以及关节隐窝处粘连。我们的治疗理念包括积极的物理治疗，若保守治疗失败则尽早进行关节镜手术。对于存在数年持续性屈曲挛缩的病例，通过后内侧关节切开术进行后关节囊切开术。在对关节纤维化进行关节镜治疗17个月后接受复查的16例患者中，平均活动范围改善为伸直13度、屈曲25度。另外7例慢性屈曲挛缩持续1年或更长时间的患者接受了后关节囊切开术，并在术后18个月接受复查。随访时这些患者伸直的平均改善度数为15度。
