关节镜治疗初次全膝关节置换术后关节僵硬的临床分析

目的探讨关节镜治疗初次全膝关节置换术后膝关节僵硬的临床疗效。方法对12例初次全膝关节置换术后膝关节僵硬的患者行关节镜松解术。男4例，女8例；平均年龄71岁（56—83岁）。排除因感染、假体位置不良、假体松动等其他明显原因导致膝关节僵硬的患者。手术包括重建髌上囊和内外侧沟、松解髌骨周围挛缩、切除残留的半月板或膝前结节等。采用KSS评分对膝关节术前及术后功能进行评价。结果平均随访2．3年（1～6年）。术中均可见到关节内纤维束带形成、滑膜肥厚增生和髌骨周围粘连。2例患者术中见膝前结节纤维，1例术中见假性半月板形成。3例患者行髌骨内外侧支持带松解术，5例行单纯外侧支持带松解术。术中平均屈曲度为119°（100°～130°），末次随访时为100°（95°～115°）。KSS评分从术前平均为70分提高到末次随访时平均86分。术前术后KSS评分差异有统计学意义（t=3．38，P〈0．01）。结论关节镜是治疗初次全膝关节置换术后膝关节僵硬的安全、有效方法，达到明显改善功能和加快术后康复的目的。

Arthroscopic treatment of patients with knee stiffness after primary total knee replacement

Objective To evaluate the clinical effect of arthroscopic management on the patients with knee stiffness after primary TKA. Methods A total of 12 patients with knee stiffness after primary TKA underwent arthroscoyp. There were 4 male patients and 8 female patients. The mean age was 71 years （ranged 56 - 83 years ）. All cases of knee stiffness because of infection, mechanical mal-alignment, implants loosening and other obvious reasons were excluded. Arthroscopic arthrolysis was performed in a standardized technique with releasing of all fibrous bands in the suprapatellar pouch, reestablishing the medial and lateral gutter, releasing of the patella, resection of the remaining meniseal tissue or an anterior cyclops. The clinical effect was evaluated by the knee society rating system. Results All patients were followed up for 1 to 6 years, with the mean of 2. 3 years. All the operated knees had intra-articular fibrous bands, hypertrophic synovitis and peri-patellar adhesions. 2 patients suffered from an anterior cyclops lesion and 1 patient had pseudomenicus. In 3 cases a medial and lateral release of the patella was performed, 5 patients got an isolated lateral release. The mean knee flexion was 119°（ 100° - 130°） at the end of arthroseopy and was 100° （95° - 115°） at the last follow up. The average knee society ratings increased from 70 points prior to the arthroscopy to 86 at time of last follow up, which was found to be statistically significant （t = 3.38 ,P 〈 0.01, student＇s t test）. Conclusions Arthroscopie management of knee stiffness following primary TKA is a safe and efficient method. Knee function can be improved markedly.