镜下松解与手法松解治疗全膝关节置换术后僵硬△

Arthroscopic release combined with manual release for joint stiffness following total knee arthroplasty

摘要:

[目的] 比较关节镜下松解联合手法松解与麻醉下单纯手法松解治疗全膝关节置换术后晚期关节僵硬的临床疗效。 [方法] 回顾性分析 2016 年 1 月—2019 年 8 月治疗 40 例 TKA 术后晚期僵硬患者的临床资料。依据医患沟通结果，19 例采用镜下松解联合手法松解(联合组)，另外 21 例采用单纯手法松解(手法组)。比较两组围手术期、随访和影像资料。[结果]两组患者均顺利完成手术。虽然联合组手术时间 [(65.4±12.4)min vs (27.7±5.3)min, P＜0.05] 显著长于手法组，但是前者术中最大屈膝 [(105.4±12.8)° vs (97.4±11.6)°, P＜0.05] 和伸膝角度 [(0.8±1.9)° vs (3.7±2.5)°, P＜0.05] 均显著优于后者。所有患者随访平均(26.7± 6.9) 个月，两组间完全负重活动时间差异无统计学意义 (P＞0.05)。随时间推移，两组 VAS 疼痛评分显著降低 (P＜0.05)，而膝关节 ROM、KSS 临床和 KSS 功能评分以及 HSS 评分均显著增加 (P＜0.05)。术前两组间上述指标的差异均无统计学意义 (P＞0.05)，末次随访时，联合组 HSS 评分 [(79.8±5.1) vs (74.2.±4.3), P＜0.05]、KSS 临床 [(88.6±3.4) vs (83.9±3.2), P＜0.05] 和 KSS 功能评分 [(85.7±3.5) vs (82.1±3.3), P＜0.05] 及膝关节 ROM [(93.4±6.5)° vs (87.2±6.3) °, P＜0.05] 均显著优于手法组。影像方面，随时间推移，两组患者 FTA 角、假体松动和异位骨化均无显著变化 (P＞0.05)，相应时间点，两组上述指标的差异均无统计学意义 (P＞0.05)。[结论]镜下松解联合手法松解治疗 TKA 术后晚期僵硬能有效改善膝关节活动度，具有良好的临床疗效和较低的并发症发生率。

Abstract:

[Objective] To compare the clinical efficacy of arthroscopic release combined with manual release versus manual release only under anesthesia for advanced joint stiffness following total knee arthroplasty (TKA). [Methods] A retrospective study was performed on 40 patients who received release for advanced knee stiffness after TKA from January 2017 to August 2021. According to doctor-patient communication, 19 patients received arthroscopic release combined with manual release (the combined group), while the other 21 patients received manual release alone. The documents regarding perioperative period, follow- up and images were compared between the two groups. [Results] All patients in both groups were operated smoothly. Although the combined group consumed significantly longer operative time [(65.4±12.4)min vs (27.7±5.3)min, P＜0.05] than the manual group, the former got significantly greater maximum knee flexion [(105.4± 12.8)° vs (97.4±11.6)°, P＜0.05] and knee extension [(0.8±1.9)° vs (3.7±2.5)°, P＜0.05] than the latter intraoperatively. All patients were fol- lowed up for a mean of (26.7±6.9) months, and there was no significant difference in the time to resume full weight-bearing activity between the two groups (P＞0.05). The VAS score for pain decreased significantly (P＜0.05), while the KSS clinical and functional scores, HSS score as well as knee extension-flexion range of motion (ROM) increased significantly in both groups over time (P＜0.05). There was no significant difference in the above indexes between the two groups before surgery (P＜0.05), but the combined group proved significantly superior to the manual group in terms of HSS score [(79.8±5.1) vs (74.2±4.3), P＜0.05], KSS clinical score [(88.6±3.4) vs (83.9±3.2), P＜0.05], KSS function score [(85.7±3.5) vs (82.1±3.3), P＜0.05], and knee ROM [(93.4±6.5)° vs (87.2±6.3)°, P＜0.05] at the latest follow-up. Radiographically, fem- orotibial angle (FTA), states of prosthesis loosening, and ectopic ossification remained unchanged over time in both groups (P＞0.05), which were not significantly different between the two groups at any corresponding time points (P＞0.05). [Conclusion] The arthroscopic release combined with manual release does effectively improve the knee range of motion with good clinical efficacy and low complications for the knee stiffness following TKA.