Clinical And Experimental Study Of Lysis Treatment In Knee Joint Stiffness Causing By Injury

Objective:The bone fracture of the knee joint is usually in clinic. Knee joint stiffness after injury causing is a common complication in knee joint of the bone fracture after the operation. Formation of musculus quadriceps fexoris and Lysis of knee joint are classical treatment. But this kind of operation owns too many complications trauma and functional reconstruction and rehabilitation has been a difficult problem in the treatment of knee joint stiff causing by injury.Operation is the only effective and feasible one in all sorts of methods which most surgeon favorites.Malpractice exists even for the improved operation of formation of musculus quadriceps fexoris and Lysis of knee joint.It is a hard task for the surgeons to find an effective way of operation causing little wounds and complications.In our study, we discuss a micro injury method to treat knee joint stiff causing by injury and describe some relative questions in knee joint lysis. In our study we emphasize the functional exercise after operation. Meanwhile,to discuss the effects of different movements on the recovery of full-thickness cartilage defects,the model of full-thickness cartilage defects on rabbit was constructed and help the guide functional exercise of the patient supplying the effectively experimental evidence.Method:1 Clinical observations: minimally invasive operation was used for the treatment of knee joint stiff after injury in patients from March, 2002 to March, 2008. The patients, aging from 18 to 50 years old and including 18 men and 8 women have disease courses from 8 to 36 months. The causes of disease are 10 fracture of shaft of femur, 13 fractures of condyles of femur and the middle of ondyles of femurs, 2 fractures of tibial plateau and upper part of shinbone, and fractures of inferior segment of femoral bone complicating patellar fracture. Knee joints take flexuosity with angle from 10 to 60. Median incision in superior border of kneecap was used. The operation including isolation of tendon of rectus femoris, cutting down the tendon of musculus vastus on whirbone adhesions point, cutting pavilion of musculus quadriceps fexoris for 3-5 cm along superior margin of whirbone, solution of adhering zone in patellofemoral joint and genuflexion for an angle of 110 to 120. Legs rose positively and knee join was exercised continually after 24 hours.2 Experimental research:24 adult New-Zealan rabbit were used and depart random to passively move group, active move group, and cypsum fibrosum fixed group which owns 8 rabbits respectively for each group. All the rabbits were made to models of knee joint full thick cartilago articularis defect and take proper exercises after operation. Experimental materials were drawn in 4 and 8 weeks respectively. Thus, 4 rabbits were sacrificed each time for each group. Samples were observed on the whole and under microscope to learn their macroscopic and microcosmic information of union of fracture.Result:1. Clinical observations:StageⅠconcrescent was observed in the cut. 6 months to 2 years follow up showed the inflection rang 80°～110°and no Cutaneous necrosis occurred before knee cap. According to the standard by Judet, genuflex exceed 100°,80°～100°,50°～80°,and less than 50°are definited as rank A, B, C, and D respectively. In the patient we observed, 20 A, 5 B, 1 C and 0 D rank were found according Judet's standard. 96% A showed the results were good in therapeutic effect.2. Experimental research: general observation: 4 weeks after operation, the whole surface defect of articulation recovered in passively move group. The surface was smooth with white, fine and solid materials in the defect zone and was lower than its surrounding tissues.For the active move group, incompletion of recovery was found; the defect zone was filled with red and semitransparent granulation tissue which had an obvious margin to its surrounding tissue.And for the cypsum fibrosum fixed group, the defect was filled with red granulation tissue, lower than its surrounding tissue and has an obvious limit to the cartilage surrounded. 8 weeks after operation,further recovery was found in passively move group, the color of the defected zone and its surrounding cartilage was same on the whole. For the active move group, the defected zone was fixed by dark red, semitransparent tissues and lower than its surrounding tisse. And for the cypsum fibrosum fixed group, the defect was filled with dark red granulation tissue, lower than its surrounding tissue and has an obvious limit to the cartilage surrounded.Histology research:The predominance tissue in passively move group was hyaline cartilage with nearly the same thick to normal cartilage. Many cartilage cells line up in order were found. The lower tidal line of cartilage partly recovered. In active move group the fix tissues were mainly hyaline cartilage and cartilago fibrosa and were thinner than normal cartilage. The fixed tissues were closely connected to their nearer cartilage. The cartilage cells were less and the arrangements of the cells were irregular. The lower tidal line of cartilage was vague. In cypsum fibrosum fixed group, the fix tissues were mainly cartilago fibrosa and were thinner than normal cartilage. The cartilage cells were less and the arrangements of the cells were irregular. The lower tidal line of cartilage was not found. After 8 weeks, cartilage defects in passively move group were further recovered. Fibra and granulation tissue was main fixed tissues in Active move group and cypsum fibrosum fixed group.There were less cartilage cells with derangement and without intercellular layer. Conclusion:1. Micro invasive lyses operation in knee joint stiff owns advantages as minimal wound, early recovery, easy and safe operating, little complications, and most importantly good therapeutic effect.2. Passively movements are most useful to the recovery of the cartilage of the rabbit's knee. And the regeneration tissues are close to normal cartilage tissue.