兔膝关节持续被动活动对前交叉韧带重建术后切口局部组织血氧饱和度的影响

Effects of Continuous Passive Motion on Blood Oxygen Saturation in Local Wound Tissue after Anterior Cruciate Ligament Reconstruction in Rabbits

目的 探讨膝关节持续被动活动（continuous passive motion, CPM）对兔前交叉韧带重建术后切口局部组织血氧饱和度的影响. 方法 20 只八月龄雄性新西兰大白兔右侧后肢膝关节行自体双股半腱肌腱移植重建前交叉韧带手术,术后随机分为2组：自由活动组（n＝10）和CPM组（n＝10）.自由活动组笼内自由活动;CPM组应用兔膝关节持续被动活动器运动.术后第2天,近红外光技术装置ODISseyTM 局部组织血氧监护仪测量每一来回（屈曲30°～110°）不同CPM速度（分别为2.35°/s、3.2°/s 、8°/s）时的切口局部组织血氧饱和度（tissue oxygen saturation ,StO2）变化,选择最好的CPM范围和速度.分别在术前和术后第2、4、6、8、10、14天观察膝关节CPM不同角度时切口局部组织StO2的变化. 结果 与自由活动组相比,3种速度的CPM在不同屈曲角度下均保持较高的StO2,且有显著性差异（P＜0.05）,不同CPM速度之间StO2有显著性差异（P＜0.05）.每一来回（屈曲30°～110°）运动速度为3.2°/s时保持最高的StO2.在术前和术后第2、4、6、8、10、14天等各时间点,膝关节屈曲30°、60°、90°、110°时StO2均无显著性差异（P＞0.05）,不同的时间点（术前和术后第2、4、6、8、10、14天）切口的StO2差别均有显著统计学意义（P＜0.05）.术后第2～4天最低,然后逐渐上升.术后第2周拆线后,切口愈合良好,没有感染、血肿和切口裂开. 结论 兔膝前交叉韧带重建术后第2天开始进行膝关节CPM（屈曲30°～110°）,可增加切口局部组织血氧饱和度,以3.2°/s的CPM速度最佳.

Objective To study the effects of continuous passive motion （CPM） on tissue blood oxygen saturation （ StO2 ） in the edge of wound after anterior cruciate ligament （ACL） reconstruction in rabbits. Methods Twenty male New Zealand rabbits, aged 8 months, received an ACL reconstruction by using double semitendinous tendon autograft in the right hind leg. The rabbits were randomly divided into 2 groups postoperatively, namely Cage activity group （ n = 10） and CPM group （ n = 10） , treated with cage activity and activity by rabbit knee joint continuous passive motion apparatus respectively. On the following day after operation, a nearinfrared optical device and ODISseyTM Tissue Oximeter were applied to measure the changes of tissue oxygen saturation （ StO2） in the edge of the wound in each cycle （with flexion of 30° - 110°） and various CPM speeds （2.35°/s, 3.2°/s, and 8°/s） , and the optimal CPM range and speed was thus selected for analyzing the changes of StO2 in local tissues of wounds with various angles of CPM in knee joint before the operation and on the 2nd, 4th, 6th, 8th, 10th, and 14th postoperative days. Results There was a significant difference with regard to StO2 between CPM group and Cage activity group （ P 〈 0. 05 ） , and also among different CPM speed （ P 〈 0.05 ）. The StO2 kept at the highest level when CPM speed was 3.2°/s in each complete cycle （flexion degree at 30° - 110° ）. Before the operation and on the 2nd, 4th, 6th, 8th, 10th and 14th postoperative days, there was no significant difference in StO2 among different flexion degree （30°, 60°, 90°, and 110°） （P 〉 0.05 ） , however, a significant difference was observed among different time points （before the operation, and 2, 4, 6, 8, 10, 14 days after the operation） （P 〈 0. 05） , where StO2 reached the bottom level between the 2nd and 4th days, and gradually increased thereafter. There was no infection, haematoma or disruption of wound after removing the suture in the 2nd postoperative week. Conclusions Starting knee joint CPM （flections of 30° - 110°） the day after ACL reconstruction can increase the StO2 in local tissue of wound, with the optimal speed of CPM at 3.2°/s.