CAJ | 학술논문

目的：探讨烧伤后合并膝关节伸直位僵硬的手术松解方式及术后康复方法。方法2007年6月至2011年12月，收治的11例(16膝)烧伤后合并膝关节僵硬患者，男9例，女2例，年龄19～54(平均33.2)岁。僵硬时间8～26(平均12.6)个月。术前屈曲度5°～50°(平均26.2±11.9)°。术前HSS膝关节功能评分46～72(平均55.8±6.9)分。对僵硬膝关节实施关节松解术，分离关节内粘连，切断挛缩和纤维化的股中间肌，游离深浅筋膜层增加皮肤延展性。术中将膝关节松解至屈曲角度90°以上，用翻转的筋膜瓣在屈膝90°位缝合深筋膜层，皮下组织和皮肤原位缝合，不行植皮手术。术后将膝关节固定在不导致髌前皮肤发白缺血的最大屈曲位，固定72 h，积极进行早期康复治疗，观察治疗前后皮肤覆盖、关节活动度和关节功能恢复情况。术后随访18～36(平均25.7)个月。结果膝关节屈曲度110°～135°(平均122.2±11.0)°，和手术前相比增加96.0°( P＜0.01)，皮肤延展性增加，可以满足关节屈曲度增加的需要。随访结束时HSS膝关节功能评分93～100(平均97.5)分，比术前增加41.7分(P＜0.01)，关节功能明显改善。结论对于烧伤后膝关节伸直位僵硬的关节松解术，可以采取挛缩带松解和深浅筋膜间游离但不予植皮的方式进行，术后短期屈曲位固定和积极的康复治疗是改善皮肤延展性和关节功能的关键措施。
목적：탐토소상후합병슬관절신직위강경적수술송해방식급술후강복방법。방법2007년6월지2011년12월，수치적11례(16슬)소상후합병슬관절강경환자，남9례，녀2례，년령19～54(평균33.2)세。강경시간8～26(평균12.6)개월。술전굴곡도5°～50°(평균26.2±11.9)°。술전HSS슬관절공능평분46～72(평균55.8±6.9)분。대강경슬관절실시관절송해술，분리관절내점련，절단련축화섬유화적고중간기，유리심천근막층증가피부연전성。술중장슬관절송해지굴곡각도90°이상，용번전적근막판재굴슬90°위봉합심근막층，피하조직화피부원위봉합，불행식피수술。술후장슬관절고정재불도치빈전피부발백결혈적최대굴곡위，고정72 h，적겁진행조기강복치료，관찰치료전후피부복개、관절활동도화관절공능회복정황。술후수방18～36(평균25.7)개월。결과슬관절굴곡도110°～135°(평균122.2±11.0)°，화수술전상비증가96.0°( P＜0.01)，피부연전성증가，가이만족관절굴곡도증가적수요。수방결속시HSS슬관절공능평분93～100(평균97.5)분，비술전증가41.7분(P＜0.01)，관절공능명현개선。결론대우소상후슬관절신직위강경적관절송해술，가이채취련축대송해화심천근막간유리단불여식피적방식진행，술후단기굴곡위고정화적겁적강복치료시개선피부연전성화관절공능적관건조시。
Objective To investigate the methods of release surgery and postoperative rehabilitation of postburn extension contracture of the knee.Methods From June 2007 to December 2011, 11 patients with 16 postburn stiff knees were adopted, including 9 males and 2 females. Their mean age was 33.2 years old ( range; 19-54 years ), and the average stiffness period was 12.6 months ( range; 8-26 months ). The mean range of lfexion was ( 26.2±11.9 ) degrees preoperatively ( range; 5-50 degrees ). The Hospital for Special Surgery ( HSS ) knee function score was ( 55.8±6.9 ) points preoperatively ( range; 46-72 points ). Release surgery was performed in all stiff knees. The intra-articular adhesion was totally released, and the contractural and ifbrous vastus intermedius was cut off. The deep and superifcial fascias were freed to increase the skin ductility. More than 90 degrees of lfexion was observed in all the knees during the operation, and the reversed fascial lfap was used to suture the deep fascia in the position of lfexion of 90 degrees. The skin was sutured with subcutaneous tissues in situ, and skin transplantation was not performed. After the operation the knee joint was immobilized in the maximum lfexion position for 72 hours, and meanwhile the pre-patellar skin would not become pale or ischemic. All the patients actively started early rehabilitation. The skin coverage, range of motion and functional restoration of the joint were observed before and after the treatment. All the patients were followed up for a mean period of 25.7 months ( range; 18-36 months ).Results The range of lfexion was ( 122.2±11.0 ) degrees on average after the treatment, ( range; 110-135 degrees ), which was increased by 96.0 degrees when compared with that preoperatively (P<0.01 ). The range of lfexion was increased to meet the demand after the increase of skin elongation. The mean HSS knee function score was 97.5 points in the latest follow-up ( range; 93-100 points ), which was increased by 41.7 points when compared with that preoperatively (P<0.01 ). The knee function was obviously improved.Conclusions For the patients with postburn extension contracture of the knee, release surgery is a good choice with the contractural tissues released and the deep and superifcial fascias separated. However,skin transplantation is not performed. The short-term immobilization in the lfexion position and active rehabilitation after the operation may be the crucial measures to improve the skin elongation and the knee function.