保留股内侧肌止点微创技术结合关节镜治疗膝关节僵.docVIP

保留股内侧肌止点的微创技术结合关节镜治疗膝关节僵 　　作者：林光锚 作者单位：温州医学院第三附属医院骨科，浙江 瑞安 325200 　　【摘要】 探讨关节镜辅助下小切口松解治疗膝关节僵直的方法和效果。[方法]26例膝关节纤维性僵直，采用髌骨外上方小切口，用剪刀松解髌股关节、内外侧支持带与股骨间、股中间肌与股骨间，以及髌下脂肪垫与股骨髁之间的粘连，在髌骨外侧1 cm处切开髌外侧支持带及用剪刀在股内侧肌止点内侧切开髌骨内侧支持带，再在关节镜下清理关节内断裂及残留的粘连束带和髁间凹瘢痕组织并止血，结合徒手推拿松解。[结果]随访8～32个月，平均19个月，膝关节活动度从术前平均32°增至113°，平均提高81°。无皮肤坏死、创口裂开、肌腱断裂、骨折等并发症。[结论]关节镜辅助下小切口松解治疗膝关节纤维性僵直手术操作简单，创伤小，康复快。保留股内侧肌止点对保留伸膝力量、维持膝关节稳定、膝关节功能恢复及减少皮肤坏死等并发症有重要意义。 　　【关键词】 膝关节 关节镜检查 粘连 治疗 　　Arthroscopically assisted mini-incision arthrolysis for the stiff knee∥CAI Chunyuan,YANG Guojing,LI Yongjiang,et al.Department of Orthopaedics,The 3rd Affiliated Hospital of Wenzhou Medical College,Zhejiang,325200,China 　　Abstract：[Objective]To discuss the method and effectiveness of arthroscopically assisted miniincision arthrolysis for the stiff knee.[Method]A small lateral suprapatellar incision was made in all 26 patients suffered from stiff knee,and the scissors were introduced the joint to release the adhesive tissues of patellofemoral joint.All adhesive tissues between the medial,lateral retinaculum and the femur,and the between vastus intermedius and femur were released subsequently.After the release of the adherence between the fat pad and femoral condyle,the lateral retinaculum was dissected 1 cm lateral to the patellae,and the dissection of medial retinaculum was applied at the insertion of the vastus medialis.Eventually,arthroscopic debridement and hemostasis combined with manipulative release was applied to remove all remanent adhesive bundles and scar tissues.[Result]Followups were maintained for an average of 19 months(range,from 8-32 months).An increase in the average range of motion of the knee was attained from 32 degrees preoperatively to 113 degrees postoperatively.No complications such as skin necrosis,wound dehiscence,tendon rupture and fracture had occurred during the followup period.[Conclusion]The advantages of arthroscopically assisted miniincision arthrolysis for the stiff knee in