上海交通大学学报（医学版）

上海交通大学学报（医学版） >

2021 , Vol. 41 >Issue 4: 479 - 482

DOI: https://doi.org/10.3969/j.issn.1674-8115.2021.04.010

论著·临床研究

程序化麻醉下手法松解术治疗膝关节创伤术后关节粘连的21例临床报告

  • 姜鑫 ,
  • 贺英 ,
  • 蔡斌 ,
  • 范帅 ,
  • 李晓燕 ,
  • 康志斌
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  • 1.上海市奉贤区奉城医院康复医学科，上海 201411
    2.上海交通大学医学院附属第九人民医院康复医学科，上海 200011
姜鑫（1984—），女，主管技师，学士；电子信箱：jiangxinkylie@163.com。

收稿日期: 2020-05-18

  网络出版日期: 2021-05-14

基金资助

国家重点研发计划(2018YFF0300504);上海市奉贤区临床诊疗中心建设计划(fxlczlzx-a-201706);上海市奉贤区社会类科技发展基金(20181901)

收起

Procedural manipulation under anesthesia for joint adhesion after trauma of knee operation: report of 21 cases

  • Xin JIANG ,
  • Ying HE ,
  • Bin CAI ,
  • Shuai FAN ,
  • Xiao-yan LI ,
  • Zhi-bin KANG
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  • 1.Department of Rehabilitation Medicine, Fengcheng Hospital of Fengxian District, Shanghai 201411, China
    2.Department of Rehabilitation Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China

Received date: 2020-05-18

  Online published: 2021-05-14

Supported by

National Key R&D Program of China(2018YFF0300504);Construction Plan of Clinical Diagnosis and Treatment Center of Fengxian District in Shanghai(fxlczlzx-a-201706);Shanghai Fengxian District Social Science and Technology Development Fund(20181901)

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摘要

目的·探讨使用程序化麻醉下手法松解术（manipulation under anesthesia，MUA）治疗膝关节创伤术后关节粘连的临床疗效及安全性。方法·入选21例膝关节创伤术后关节粘连患者（包括膝关节多韧带损伤重建和/或修补术后6例、膝关节周围骨折内固定术后9例、髌骨脱位术后6例），行程序化MUA。使用关节量角尺评估患者在程序化MUA前、中、后随访（2周、12周、24周）的屈膝角度；使用视觉模拟评分法（visual analogue scale，VAS）评估患者在程序化MUA后2周内的疼痛程度；记录患者于程序化MUA中、后可能出现的并发症。结果·程序化MUA前、中、后随访（2周、12周、24周），患者的平均屈膝角度分别为73.8°、119.3°、101.7°、122.5°、127.4°。与术前相比，程序化MUA后24周的平均屈膝角度增加了53.6°。VAS评估结果显示，患者仅在术后1~3 d活动状态下的评分超过4分。术中及术后均未有并发症发生。结论·程序化MUA治疗膝关节创伤后关节粘连相对安全且有效。

关键词： 关节粘连; 膝关节创伤; 麻醉下手法松解术

本文引用格式

姜鑫 , 贺英 , 蔡斌 , 范帅 , 李晓燕 , 康志斌 . 程序化麻醉下手法松解术治疗膝关节创伤术后关节粘连的21例临床报告[J]. 上海交通大学学报（医学版）, 2021 , 41(4) : 479 -482 . DOI: 10.3969/j.issn.1674-8115.2021.04.010

Abstract

Objective

· To investigate the clinical efficacy and safety of procedural manipulation under anesthesia (MUA) for joint adhesion after trauma of knee operation.

Methods

· Twenty one patients with joint adhesion after trauma of knee operation (including 6 cases after reconstruction and/or repair of multiple ligament injury of knee joint, 9 cases after internal fixation of fracture around the knee joint, and 6 cases after operation of patellar dislocation) were treated with procedural MUA. The knee flexion angle was evaluated before, during and after procedural MUA (2, 12 and 24 weeks) with joint protractor. The pain degree was evaluated by visual analogue scale (VAS) within 2 weeks after procedural MUA. The possible complications were recorded during and after procedural MUA.

Results

·Before, during and after procedural MUA (2, 12 and 24 weeks), the average knee flexion angle was 73.8°, 119.3°, 101.7°, 122.5° and 127.4°. Compared with preoperative, the average knee flexion angle increased 53.6° after procedural MUA (24 weeks). VAS evaluation results showed that the VAS score of patients in active state was more than 4 points only 1?3 days after operation. No complications occurred during and after the operation.

Conclusion

· Procedural MUA is relatively safe and effective in the treatment of joint adhesion after trauma of knee operation.

Key words： joint adhesion; trauma of knee; manipulation under anesthesia (MUA)

参考文献

1 Magit D, Wolff A, Sutton K, et al. Arthrofibrosis of the knee[J]. J Am Acad Orthop Surg, 2007, 15(11): 682-694.
2 McAlister I, Sems SA. Arthrofibrosis after periarticular fracture fixation[J]. Orthop Clin N Am, 2016, 47(2): 345-355.
3 Dodds JA, Keene JS, Graf BK, et al. Results of knee manipulations after anterior cruciate ligament reconstructions[J]. Am J Sports Med, 1991, 19(3): 283-287.
4 Noyes FR, Berrios-Torres S, Barber-Westin SD, et al. Prevention of permanent arthrofibrosis after anterior cruciate ligament reconstruction alone or combined with associated procedures: a prospective study in 443 knees[J]. Knee Surg Sports Traumatol Arthrosc, 2000, 8(4): 196-206.
5 Sanders TL, Kremers HM, Bryan AJ, et al. Procedural intervention for arthrofibrosis after ACL reconstruction: trends over two decades[J]. Knee Surg Sports Traumatol Arthrosc, 2017, 25(2): 532-537.
6 刘丽琨, 蔡斌, 岳冰, 等. 前交叉韧带重建术后关节粘连患者的综合物理治疗30例报告[J]. 中国骨与关节杂志, 2016, 5(10): 743-746.
7 王予彬, 王惠芳. 关节镜手术与康复[M]. 北京: 人民军医出版社, 2007.
8 姜鑫, 蔡斌, 王留根, 等. 程序化麻醉下手法松解术治疗膝关节粘连20例临床报告[J]. 中国康复, 2018, 33(5): 482-484.
9 Sassoon AA, Adigweme OO, Langford J, et al. Manipulation under anesthesia: a safe and effective treatment for posttraumatic arthrofibrosis of the knee[J]. J Orthop Trauma, 2015, 29(12): E464-E468.
10 Ipach I, Mittag F, Lahrmann J, et al. Arthrofibrosis after TKA: influence factors on the absolute flexion and gain in flexion after manipulation under anaesthesia[J]. BMC Musculoskelet Disord, 2011, 12(1): 1-6.
11 Kukreja M, Kang J, Curry EJ, et al. Arthroscopic Lysis of adhesions and anterior interval release with manipulation under anesthesia for severe post-traumatic knee stiffness: a simple and reproducible step-by-step guide[J]. Arthrosc Tech, 2019, 8(5): E429-E435.
12 Stiefel EC, McIntyre L. Arthroscopic Lysis of adhesions for treatment of post-traumatic arthrofibrosis of the knee joint[J]. Arthrosc Tech, 2017, 6(4): E939-E944.
13 Thompson R, Novikov D, Cizmic Z, et al. Arthrofibrosis after total knee arthroplasty: pathophysiology, diagnosis, and management[J]. Orthop Clin N Am, 2019, 50(3): 269-279.
14 Saini P, Trikha V. Manipulation under anesthesia for post traumatic stiff knee-pearls, pitfalls and risk factors for failure[J]. Injury, 2016, 47(10): 2315-2319.
15 Dailey K, McMorris M, Gross MT. Tibiofemoral joint mobilizations following total knee arthroplasty and manipulation under anesthesia[J]. Physiother Theory Pract, 2020, 36(7): 863-870.
16 Ghani H, Maffulli N, Khanduja V. Management of stiffness following total knee arthroplasty: a systematic review[J]. Knee, 2012, 19(6): 751-759.
17 Haller JM, Holt DC, McFadden ML, et al. Arthrofibrosis of the knee following a fracture of the tibial plateau[J]. Bone Joint J, 2015, 97-B(1): 109-114.
18 Evans KN, Lewandowski L, Pickett A, et al. Outcomes of manipulation under anesthesia versus surgical management of combat-related arthrofibrosis of the knee[J]. J Surg Orthop Adv, 2013, 22(1): 36-41.
19 Mariani PP, Santori N, Rovere P, et al. Histological and structural study of the adhesive tissue in knee fibroarthrosis: a clinical-pathological correlation[J]. Arthroscopy, 1997, 13(3): 313-318.
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