Objective To evaluate the clinical effect of manipulation under anaesthesia (MUA) with assist of lateral parapatellar micro incision on the patients with stiff knees in early stage after primary total knee arthroplasty (TKA).M ethods Ten patients (3 males,7 females) with stiff knees after TKA (within 6 weeks) were treated with ML A with assist of lateral parapatellar micro incision. The average range of motion (ROM ) before ML A was 74. 4+ 9. 44°(60°~ 85°). Cases with stiff knees because of definite reasons such as infection , mechanical mal-alignment, mplants loosening were excluded. ML A with assist of lateral parapatellar incision were performed on these 10 cases under spinal a anesthesia with gentle,continuous and repeated force to reach maximum ROM. The clinical effect was evaluated by the Knee Society Rating System (KSS score). Results All patients were followed up for 1 to 4 years, with mean of 2. 6 years. The mean knee ROM was 112. 5± 9. 20°(100°~ 125°) at the end of MLA ,and wasl05± 6. 97° (95°~ 115°) at the last follow up. The average KSS score increased from 69 points to 82 points by the end of follow-up, And the kss increase was statistically significant (t= 14. 40,P< 0. 01,T test). Conclusion MLA with assist of lateral parapatellar micro incision is a safe and efficient way to treat with knee stiffness in early stage after primary TKA.%目的 探讨髌外侧小切口辅助麻醉下手法松解治疗初次全膝关节置换术后早期膝关节僵硬的临床疗效.方法 对10 例初次全膝关节置换术后早期(6周内)发生膝关节僵硬的患者行髌外侧小切口辅助麻醉下手法松解.其中男性3 例,女性7 例;术前膝关节平均活动度为(74.4±9.44)°(60°～85°),平均年龄(72.8±7.18) 岁(59～81 岁).排除因感染、假体松动、假体位置不良等明确原因导致术后关节僵硬的患者.术中给予蛛网膜下腔麻醉,反复、柔和、持续地对膝关节进行手法松解,结合髌外侧小切口,使其达到最大的活动度.采用KSS评分对膝关节术前及术后功能进行评价.结果 平均随访(2.6±1.04)年(1～4年),术中能达到的平均活动度为(112.5±9.20)°(100°～125°),末次随访时平均活动度为(105±6.97)°(95°～115°).KSS评分从术前平均69分提高到末次随访时平均82分.术前术后KSS评分差异有统计学意义(t＝14.40,P＜0.01).结论 髌外侧小切口辅助麻醉下手法松解是治疗初次全膝关节置换术后早期发生膝关节僵硬安全、有效的治疗手段,通过早期治疗,能显著改善膝关节功能.
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