Ⅱ型浮膝损伤术后膝关节功能康复

Postoperative rehabilitation of Type Ⅱ floation knee injury

目的：总结Ⅱ型浮膝损伤患者的治疗方法和手术后膝关节功能康复疗效.方法：回顾分析经治的68例患者,男57例,女11例;年龄17～60岁.68例共74侧肢体的Ⅱ型浮膝损伤-膝关节内骨折病例,其中双侧肢体Ⅱ型浮膝骨折6例.根据患者骨折类型、是否存在开放性损伤、软组织损伤程度分别采用内固定（髓内钉、解剖钢板）和支架外固定方法,术后均采用统一、系统的康复治疗.术后对治疗结果采用Karlstrom和Olerud的浮膝损伤治疗标准进行评价;使用x2检验对两种固定方法治疗后膝关节功能康复效果差别进行显著性分析.结果：所有病例均得到1～4年的随访,平均24个月.内固定组优良率64.29%,支架外固定组优良率80.43%.内固定组与支架外固定组比较,膝关节活动受限度指标有统计学差异（P＜0.05）,说明Ⅱ型浮膝损伤应当注重对关节内骨折的复位和减少对膝关节周围软组织的破坏.结论：①早期功能恢复期支架组优于内固定组;②牵引后及术后早期系统的康复治疗有利于膝关节功能恢复和减少并发症;③伸膝功能锻炼应当在牵引治疗后即开始,膝关节屈伸功能锻炼在手术后3 d进行.

Objective：To summarize the therapeutic methods and rehabilitation of knee function after operation in the patients with type Ⅱ floating knee injury. Methods：Sixty-eight patients（male 57 and female 11 with the age from 17 to 60 years） with 74 intra-articular fractures of knee joint and floating knee injuries were treated with steel plate internal fixation and bracket external fixation, which were followed by a same systemic rehabilitative treatment. All the patients were followed up for 1 to 4 years, with an average of 24 months. Resuits：The therapeutic effects on floating knee injury were evaluated with the standard recommended by Karlstrom G and Olerud S. The fineness rate produced by anatomy steel plate internal fixation and bracket external fixation are 64. 29% and 80. 43% respectively. A significant difference was found in the parameters on the activity limitation of knee joint between above two groups（P 〈 0. 05 ）, indicating that an attention should be paid to the reduction of the intra-articullar fractures and injury of the soft tissue around the knee joint. Conclusion： ①In early stage, the therapeutic effects of bracket external fixation is better than the internal fixation with steel plate;②Following the traction and （or） operation, a systemically early rehabilitation is favorable to restore knee joint function and reduce the complication ;③The exercise for the extension of knee joint should start immediately in parallel with the traction ;while the bent and extension of the knee joint should conducted three days after operation. Both articular surface severity injured and joint degrading before occurrence of injury are the major factors to cause the dysfunction of the injured knee after operation. The postoperative tracheae swollen, inflammatory reaction-infect, skin necrosis, may delay the training time of the affected limbs.