Meals R A
Wadsworth VA Medical Center, Los Angeles, California.
Clin Orthop Relat Res. 1993 Feb(287):292-303.
Periarticular and intraarticular fractures frequently cause limb swelling and joint stiffness. The two effects are widely assumed to be related--an assumption long held but never tested. Over a ten-year period, a rabbit hind limb model was developed and tested to ascertain methods of preventing or reducing limb swelling and joint stiffness after a local skeletal injury. Limb swelling was monitored for the three- to four-week duration of the studies by volume displacement, and joint stiffness was determined arthrographically. Mechanical treatment modalities tested included limb pressurization, passive motion of varying duration (from four to 24 hours daily), creation of an intraarticular hematoma, and creation of dependent edema. Chemical modalities tested included systemic and intraarticular steroids, intramuscular and oral nonsteroidal antiinflammatory drugs, topical dimethyl sulfoxide, two antihistamine drugs, and two diuretics. At statistically significant levels, all of the modalities tested affected swelling or stiffness, but only terfenadine, an antihistamine, affected both. Treatment with terfenadine resulted in decreased stiffness but increased swelling. When reviewing the results of all of the treatment modalities in concert, it is apparent that, in this model, limb swelling and joint stiffness after injury are not causally related. The significance of this work in forthcoming clinical trials for treatment of posttraumatic joint stiffness are noteworthy.
关节周围和关节内骨折常导致肢体肿胀和关节僵硬。人们普遍认为这两种影响是相关的——这一假设由来已久，但从未得到验证。在十年时间里，建立并测试了一种兔后肢模型，以确定预防或减轻局部骨骼损伤后肢体肿胀和关节僵硬的方法。在为期三到四周的研究中，通过体积位移监测肢体肿胀情况，并通过关节造影确定关节僵硬程度。所测试的机械治疗方式包括肢体加压、不同时长（每天4至24小时）的被动运动、关节内血肿的形成以及下垂性水肿的形成。所测试的化学治疗方式包括全身性和关节内使用类固醇、肌肉注射和口服非甾体抗炎药、局部使用二甲亚砜、两种抗组胺药以及两种利尿剂。在具有统计学意义的水平上，所有测试的治疗方式均对肿胀或僵硬有影响，但只有抗组胺药特非那定对两者均有影响。使用特非那定治疗导致僵硬程度降低，但肿胀程度增加。综合审视所有治疗方式的结果时，很明显，在该模型中，损伤后的肢体肿胀和关节僵硬并无因果关系。这项研究成果在即将开展的创伤后关节僵硬治疗临床试验中的意义值得关注。
