膝关节粘连关节镜下射频汽化消融松解术  

Arthroscopic release with radiofrequency vaporization for knee joint stiffness

作　　者：蔡谞[1] 刘玉杰[1] 王岩[1] 李众利[1] 王志刚[1] 张文涛[1] 樊宇平[1] 王达文[1] 柴伟[1] 

机构地区：[1]解放军总医院骨科,北京100853

出　　处：《中华创伤杂志》2006年第9期652-655,共4页Chinese Journal of Trauma

摘　　要：目的总结关节镜下射频汽化消融技术在膝关节粘连松解术中的应用体会及短期临床效果。方法2002年1月至2005年6月,对各种原因所致膝关节粘连32例行关节镜下射频汽化消融粘连松解术。依据关节造影所示粘连程度分为3组：A组18例髌上囊粘连,单纯做髌上囊及内外侧沟上方成形。B组8例主要为关节间隙粘连,在做髌上囊及侧沟粘连带清理后加髁问窝清理,加压屈曲膝关节,切断内外侧关节间隙粘连带。C组6例膝关节大部分粘连,进镜操作困难者加做髌骨内外上极小切口,先做髌上囊钝性分离造成腔隙,然后镜下进一步松解。松解配合推拿。射频汽化电极点凝行关节腔内彻底止血。术后不留置引流,第2天开始被动结合主动膝关节加压屈伸功能锻炼。结果A组术前屈曲35°～75°,术后3周115°～125°,平均改善78°；B组术前屈曲40°～60°,术后3周95°～120°,平均改善72°；C组术前屈曲25°～45°,术后3周90°～110°,平均改善64°。术后关节腔内无积血,关节及其周围组织肿胀轻。结论关节镜下射频汽化消融松解膝关节粘连出血少,创伤小,松解效果可靠,可避免以往方法的不利因素,对于髌上囊、侧沟或关节间隙粘连的患者尤为适用。Objective To evaluate the advantages and short term clinical results of arthroscopic release with radiofrequeney vaporization for knee joint stiffness. Methods Arthroscopic release with radiofrequency vaporization was done in 32 cases with knee joint stiffness resulted from various causes between January 2002 and June 2005. According to degree of stiffness, 32 cases were divided into three groups, ie, Group A （ 18 cases with suprapatellar bursa adhesions） treated with confectioning at suprapatellar bursa and lateral grooves ; Group B （ eight cases with joint compartment adhesions ） managed with debridement at suprapatellar bursa and lateral groove and intercondyloid fossa, bending the knee with pressure and abscising the adhesion part in the joint compartment with radiofrequency vaporization; and Group C （six cases with must part of the joint adhered） treated by making small incision at the lateral or medial upper pole of the patellar as well as a space at the suprapatellar bursa by blunt dissection when it was difficult to insert arthroscope. After that, release combined with massage manipulation and thorough hemostasis by radiofrequeney vaporization were carried out. There was no drainage after operation. Passive and active flexion and extension exercises with pressure began two days after operation. Results Pre-operative limitation of flexion was 35 °- 75 ° that was increased to 115°- 125° three weeks after operation, with mean improvement of 78° in Group A. Pre-operative limitation of flexion was 40°-60°that was increased to 95°-120° three weeks after operation, with mean improvement of 72°in Group B. Pro-operative limitation of flexion was 25°- 45°that was increased to 90°-110° three weeks after operation, with mean improvement of 64°in Group C. No haematocele occurred postoperatively, with only slight swelling of the knee. Conclusion Arthroscopic release with radiofrequency vaporization for knee joint stiffness is characterized by less bleeding, minor trauma and reliable release a

关 键 词：膝关节 粘连 关节镜 射频汽化 

分 类 号：R687.4[医药卫生—骨科学]