膝關(guān)節(jié)外傷術(shù)后粘連的綜合預(yù)防

1、膝關(guān)節(jié)外傷術(shù)后粘連的綜合預(yù)防    【關(guān)鍵詞】  ,膝關(guān)節(jié)；外傷；粘連；預(yù)防摘要  目的  探討股骨髁上骨折、股骨髁間骨折、脛骨平臺(tái)骨折等膝關(guān)節(jié)外傷術(shù)后膝關(guān)節(jié)粘連的綜合預(yù)防。方法  統(tǒng)計(jì)近5年筆者經(jīng)治的股骨髁上骨折、髁間骨折、脛骨平臺(tái)骨折患者，對(duì)膝關(guān)節(jié)功能的恢復(fù)情況作了分析。結(jié)果  治療組94例，術(shù)后隨訪13年。膝關(guān)節(jié)活動(dòng)功能優(yōu)45例，良34例，中10例，差5例，優(yōu)良率為84.0%。對(duì)照組77例，對(duì)照組膝關(guān)節(jié)活動(dòng)功能優(yōu)28例，良21例，中17例，差11例，優(yōu)良率為63.6%，兩組間優(yōu)良率差異有顯著性（P0

2、.05）。結(jié)論  對(duì)股骨髁上骨折、股骨髁間骨折、脛骨平臺(tái)骨折等膝關(guān)節(jié)外傷患者術(shù)后進(jìn)行膝關(guān)節(jié)粘連的綜合預(yù)防，療效滿意。關(guān)鍵詞  膝關(guān)節(jié)；外傷；粘連；預(yù)防    Study on the comprehensive prevention from postoperative adhesion of knee joint traumaAbstract  Objective  To study the comprehensive prevention from postoperative adhesion of knee joint

3、 trauma in patients with supracondylar fracture,condyles  fracture of femur or fracture of tibial plateau,etc.Methods  To analyze the knee joint function recovery of patients.General data:Among 94 cases in treatment group,70 were male and 24 were female;The average age was 39.5 years（1184y

4、ears）.The period of postoperative follow-up was 1 to 3 years.There were 22 cases with supracondylar fracture of femur,31 cases with condyles fracture of femur,41 cases with splintered fracture of tibial plateau.And 73 cases suffered from close fracture and 18 cases with open fracture.There were 77 c

5、ases in control group.Results  Forty-five cases got excellent knee joint functioning,34 cases with good knee joint functioning,10 cases with moderate knee joint functioning,5 cases with bad knee joint functioning.The effective rate of treatment group was 84.0%.Of control group 28 cases got exce

6、llent knee joint functioning,21 cases with good knee joint functioning,17 cases with moderate knee joint functioning,11 cases with bad knee joint functioning.The effective rate of control group was 63.60%.There was significant differences between the two groups （P0.05）.Conclusion  The therapeut

7、ic effectiveness of comprehensive prevention from postoperative adhesion of knee joint trauma is satisfactory.Key words  knee joint;trauma;adhesion;prevention    筆者從2000年開(kāi)始對(duì)膝關(guān)節(jié)外傷術(shù)后粘連采用綜合性的預(yù)防治療措施，在預(yù)防膝關(guān)節(jié)粘連方面取得了良好的效果，現(xiàn)報(bào)告如下。1  資料與方法1.1  一般資料  膝關(guān)節(jié)外傷包括了股骨髁上、髁間骨折，脛骨平臺(tái)骨折、髕

8、骨骨折、前后交叉韌帶損傷、半月板撕裂等，但為了便于比較，本組僅以股骨髁上、髁間骨折，脛骨平臺(tái)骨折為研究對(duì)象。治療組94例，對(duì)照組77例，全部采用了手術(shù)內(nèi)固定治療，術(shù)后隨訪13年，資料見(jiàn)表1。表1  治療組與對(duì)照組的臨床資料  （略）1.2  方法1.3  療效判定標(biāo)準(zhǔn)3  優(yōu)：膝關(guān)節(jié)自主活動(dòng)自如，可自由下蹲站起，膝關(guān)節(jié)活動(dòng)度丟失15°。良：膝關(guān)節(jié)自主活動(dòng)自如，下蹲屈膝110°，膝關(guān)節(jié)活動(dòng)度丟失20°30°。中：膝關(guān)節(jié)自主活動(dòng)尚可，下蹲屈膝90°110°，膝關(guān)節(jié)活動(dòng)度丟失30°

9、70°。差：膝關(guān)節(jié)自主活動(dòng)存在，屈膝90°，膝關(guān)節(jié)活動(dòng)度丟失70°。2  結(jié)果兩組治療結(jié)果見(jiàn)表2。3  討論外傷后膝關(guān)節(jié)粘連的治療方式盡管多種多樣，其中包括手術(shù)松解、理療、中醫(yī)中藥等，但目前的治療效果仍然欠佳，由于外傷后患肢較長(zhǎng)時(shí)間處于伸直位固定狀態(tài)，可引起患肢靜脈及淋巴液淤滯、血流減慢、組織水腫，從而形成肌肉與周圍軟組織的粘連，肌肉的伸縮性減弱，整個(gè)股四頭肌，特別是股中間肌的廣泛粘連嚴(yán)重影響膝關(guān)節(jié)功能4，5。另外，髕韌帶、髕旁韌帶的攣縮、硬化也加重影響了膝關(guān)節(jié)的活動(dòng)功能。相對(duì)而言，開(kāi)放復(fù)位內(nèi)固定患者可早期下床活動(dòng)，能較好地主動(dòng)或被動(dòng)鍛煉膝關(guān)節(jié)

10、功能，故可減少或避免膝關(guān)節(jié)功能障礙的發(fā)生?；颊邉?chuàng)傷后對(duì)病痛及治療預(yù)后有很大的恐懼心理，煩躁不安，對(duì)疼痛不耐受，尤其是被動(dòng)活動(dòng)膝關(guān)節(jié)時(shí)因傷口疼痛而擔(dān)心活動(dòng)后骨折移位或遺留殘疾而拒絕或不配合治療，為此要進(jìn)行心理康復(fù)訓(xùn)練。在患者治療前要向患者本人及家屬耐心地交代病情，包括骨折部位、程度、治療方法、術(shù)后康復(fù)方法、可能出現(xiàn)的問(wèn)題及如何預(yù)防等，使患者及家屬正確認(rèn)識(shí)疾病，樹(shù)立戰(zhàn)勝疾病的信心，最大限度地配合康復(fù)治療，以利功能恢復(fù)3。表2  兩組治療結(jié)果（略）注：=3，2=8.41，P0.05，治療組與對(duì)照組差異有顯著性    總結(jié)以上的方法，其治療要點(diǎn)有：（1）早期手術(shù)。（2）以脫水的方法消除膝