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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (04) : 504 -507. doi: 10.3877/cma.j.issn.1674-134X.2020.04.020

所属专题： 文献；

临床经验

股神经阻滞下手法松解术治疗全膝关节置换术后僵硬
高升焘1, 万连平1,†(), 张鹏1, 林均馨1, 杜建春1, 刘泽淼1   
  1. 1. 266035　青岛，山东大学齐鲁医院（青岛）关节外科
  • 收稿日期:2019-02-18 出版日期:2020-08-01
  • 通信作者: 万连平

Manipulation of knee stiffness under femoral nerve block following total knee arthroplasty

Shengtao Gao1, Lianping Wan1,†(), Peng Zhang1, Junxin Lin1, Jianchun Du1, Zemiao Liu1   

  1. 1. Department of Joint Surgery, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao 266035, China
  • Received:2019-02-18 Published:2020-08-01
  • Corresponding author: Lianping Wan
  • About author:
    Corresponding author: Wan Lianping, Email:
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高升焘, 万连平, 张鹏, 林均馨, 杜建春, 刘泽淼. 股神经阻滞下手法松解术治疗全膝关节置换术后僵硬[J]. 中华关节外科杂志(电子版), 2020, 14(04): 504-507.

Shengtao Gao, Lianping Wan, Peng Zhang, Junxin Lin, Jianchun Du, Zemiao Liu. Manipulation of knee stiffness under femoral nerve block following total knee arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2020, 14(04): 504-507.

目的

探讨股神经神经阻滞镇痛下手法松解术治疗全膝关节置换术后僵硬的临床疗效。

方法

自2013年1月至2017年12月，山东大学齐鲁医院(青岛)关节外科32例全膝关节置换术后僵硬的患者纳入本研究。在B超引导下连续股神经阻滞镇痛后行手法松解术，松解完毕后患者行主被动功能康复锻炼。记录术前及术后膝关节的屈曲度、美国膝关节学会评分(KSS)及功能锻炼时的视觉模拟评分法(VAS)评分。所得计量资料采用配对t检验。

结果

32例患者平均随访(20.4±3.1)周。松解前膝关节主动屈曲度平均(70.0±10. 8)°，松解后末次随访主动屈曲度平均(106.4±7.9)°，平均改善(36.9±7.5)°(t＝-28.5，P<0.05)。松解前KSS评分平均(78.3±2.3)分，松解后末次随访KSS评分平均(88.3±2.7)分，差异具有统计学意义(t＝-27.1，P<0.05)。功能锻炼时VAS评分平均(4.5±1.1)分，为中度疼痛。随访无假体周围骨折、伸膝装置损伤、异位骨化等并发症。

结论

股神经神经阻滞镇痛下手法松解术能有效改善全膝关节置换术后僵硬，缓解患者功能锻炼时的疼痛，具有良好的临床效果和较低的并发症。

关键词: 关节成形术, 置换, 膝, 手术后并发症, 麻醉, 手法, 骨科
Objective

To investigate the clinical effect of manipulation under femoral nerve block analgesia in the treatment of stiffness after total knee arthroplasty.

Methods

During January 2013 to December 2017, 32 patients with stiffness after total knee arthroplasty were enrolled in this study. Ultrasound-guided continuous femoral nerve block were performed, followed by manipulation with passive knee flexion to the maximum extent, and functional rehabilitation exercises performed after manipulation. The knee flexion angle before and after manipulation, KSS scores and VAS scores during functional exercise were recorded.

Results

Thirty-two patients were followed up for (20.4±3.1) weeks on average. The knee flexion angle was mean of (70.0±10.8)° before manipulation, the knee flexion angle was (106.4±7.9) ° on average at the last follow-up after manipulation under femoral nerve block analgesia(t=-28.5, P<0.05). The average improvement angle was (36.9±7.5)°. The average KSS score was (78.3±2.3) before manipulation, and was (88.3±2.7) at the last follow-up(t=-27.1, P<0.05). The VAS score during functional exercise was (4.5±1.1) on average, which was moderate pain. The patients were no periprosthetic fracture, extensor mechanism disruption or heterotopic ossification.

Conclusion

Manipulation was performed on patients with stiffness after knee arthroplasty under femoral nerve block analgesia can effectively improved knee function, and reduce the pain during manipulation.

Key words: Arthroplasty, replacement, knee, Postoperative complications, Anesthesia, Manipulation, orthopedic
图1 B超引导下行股神经阻滞镇痛
图2 股神经阻滞麻醉镇痛成功后行手法松解术
表1 松解前后膝关节屈曲度及KSS评分对比[n＝32，(±s)]
膝关节屈曲度(°) KSS评分
手法松解前 70.0±10.8 78.3±2.3
手法松解后 106.4±7.9 88.3±2.7
t值 -28.5 -27.1
P值 <0.05 <0.05
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