创伤后膝关节功能障碍治疗初期临床探究.docVIP

创伤后膝关节功能障碍治疗初期临床探究 　 作者：刘克敏，王安庆，唐涛，冯建璞，田罡，刘四海，王飞，崔志刚，崔寿昌 【摘要】 ［目的］探讨创伤后膝关节功能障碍(PKJD)的综合治疗及疗效。［方法］2001年～2005年共治疗创伤后膝关节功能障碍患者40例，42膝。治疗包括系统正规的康复手段以及手术介入。康复手段包括肌力训练、关节活动范围训练、神经生理治疗技术、身体适应性训练等；手术介入包括传统的伸膝装置黏连松解、内固定物取出同时黏连松解、小切口有限股四头肌成形+关节镜松解、Ilizarov技术。［结果］42膝住院前均未进行正规的康复治疗，入院后30膝行康复治疗，12膝手术治疗。平均膝关节活动度(ROM)入院时0°-9.2°-58.1°，股四头肌肌力Ⅲ～Ⅳ级；出院时0°-4.9°-88.9°，股四头肌力V级，治疗前后膝关节ROM相比较有统计学差异(Plt;0.01)。21例出院时仍残留5°～10°膝关节伸直迟滞，2例应用Ilizarov技术治疗效果不满意，1例治疗过程中出现精神抑郁症。22例平均19.3个月随访时膝关节均能伸直到0°，其中屈曲≥120°者15例。［结论］原始创伤处理不当和治疗后未行早期系统正规的康复训练是造成创伤后膝关节功能障碍不可忽视的原因，其治疗比较棘手，是一个长期过程，康复治疗和适当的手术介入可取得良好的效果。 【关键词】 创伤； 膝关节； 功能障碍； 治疗 　　preliminary clinical study of the management of posttraumatic knee joint dysfunction∥ 　　Abstract：［Objective］To evaluate the comprehensive clinical management of posttraumatic knee joint dysfunction(PKJD). ［Method］From 2001 to 2005，40 patients(42 knees) with posttraumatic knee joint dysfunction were treated with conservative procedures including training of muscle strength，range of motion ( ROM )，proprioception or neuromuscular control，general physical condition;and surgical procedures including Thompson’s procedures，improved Judet’s technique， extraarticular mini-invasive quadricepsplasty + intraarticular arthrofibroticlysis，Ilizarov technique.［Result］All of the 42 cases did not receive systematic rehabilitation therapy before they came in hospital. At our center，30 of them were managed conservatively and 12 of them surgically. The average ROM of the involved knee was 0°- 9.2°-58.1 at the time of admission，and 0°-4.9°-88.9° when they were discharged，the difference is significant statistically(Plt;0.01) . Twentyone cases remained 5°～10°knee extension lag.Two cases who were treated with Iizarove technique showed uncomfortable results，and 1 cases got psychosocical problem. Twentytwo cases were followed up in average 19.3 months and all the knees were able to extend to 0°.［Conclusion］Unable to receive ideal surgical treatment after trauma and systematic rehabilitation therapy