膝部骨折早期康复锻炼的意义

Significance of early rehabilitation for knee fracture

目的:膝部骨折晚期并发症为膝关节僵直、屈曲受限,为改善功能而探讨膝部骨折尤其是老年人髌骨骨折如何防治关节僵硬和骨质疏松。方法:对42例老年人髌骨骨折采用手术内固定,在术后1周内实行主动锻炼,肌肉等张收缩,2周后主动+被动锻炼,配合理疗。与保守治疗47例未做早期功能锻炼者进行膝关节活动范围和骨密度对比观察。结果:手术后早期锻炼42例,肌肉萎缩发生少,4周后膝关节可以达到正常活动范围,优良率95.2%。骨折如期愈合好,骨质疏松不显著。保守治疗组优良率为74.6%,两组比较,差异有显著性意义(t=7.63,P<0.001)。结论:良好复位、可靠固定是膝部骨折康复的基础,早期积极功能锻炼,多样康复治疗是防止老年人髌骨骨折引起关节僵硬和骨质疏松、骨性关节炎的重要方法。

AIM:The complications of advanced knee fractures are ankylosis and flexion restriction. The aim of this paper is to explore how to prevent ankylosis and osteoporosis induced by knee fractures,especially the patellar fracture in the aged patients so as to improve the function. METHODS:Forty two aged patients with patellar fracture were treated with internal fixation, and then active exercises and muscle isotonic contraction were performed within one week after operation. The active and passive exercises to match physiotherapy were performed in two weeks after operation. The range of motion(ROM)and the bone mineral density(BMD)of knee joints were compared with the data of 47 patients only receiving conservative treatment. RESULTS:The occurrence of muscular atrophy was less in 42 cases of early exercises postoperatively.The ROM of knee joints was normal after 4 weeks and the excellent rate was 95.2%. The fractures healed as scheduled and no obvious osteoporosis were found. The excellent rate of conservative treatment group was 74.6%.There was a significant difference between the two groups(t=7.63, P< 0.001). CONCLUSION:The good reduction and rigid fixation are the basis of knee fracture rehabilitation.The early active functional rehabilitation and multiple rehabilitative treatment are important methods to prevent ankylosis, osteoporosis and osteoarthritis induced by patellar fracture in the aged patients.