人工全膝关节置换后持续被动关节运动:48例分析

Continuous passive joint motion following total knee replacement: 48 cases analysis

背景:膝关节置换后的早期康复治疗逐渐引起关注,进行持续被动关节运动的主要目的是恢复膝关节功能,防止关节僵硬,同时促进手术部位血液和关节滑液循环,从而加快组织修复。目的:评价人工全膝关节置换后持续被动关节运动的疗效。方法:选择2007-12/2009-10上海瑞金医院集团闵行中心医院骨科和解放军第三○九医院康复医学科进行人工全膝关节置换的48例患者,随机分为治疗组和对照组,24例/组。两组患者在进行全膝关节置换前,给予股四头肌等长收缩等训练,并辅助物理因子治疗。治疗组患者在全膝关节置换后第2天开始进行膝关节持续被动关节运动,1h/d,每日运动范围以患者略感疼痛为宜,被动运动范围每日增加5°～10°。对照组患者全膝关节置换后抬高患肢30cm,按骨科常规方法进行临床治疗。采用膝关节外科协会评分系统评价膝关节功能,采用目测类比评分法评定患肢疼痛,通过测量双下肢周径评定患肢肿胀程度,测量膝关节活动度的变化。结果与结论:全膝关节置换前,两组患者的膝关节功能评分、VAS患肢疼痛评分、双下肢周径、膝关节活动度均基本相似(P>0.05)。与对照组比较,治疗组在置换后3d及2周膝关节功能评分显著升高(P<0.01),置换后3dVAS患肢疼痛评分及双下肢周径显著降低(P<0.01),置换后膝关节活动度明显改善,达优率显著升高(P<0.01)。48例患者均无深静脉血栓形成、感染等并发症发生。结果提示早期持续被动关节运动有助于膝关节置换后疼痛的缓解、肿胀的消除以及膝关节稳定性的增强。

BACKGROUND： Early rehabilitation following total knee replacement has arisen more attention. The aim of continuous passive joint motion is to recover knee function, prevent anchylosis, accelerate blood and synovia circulation, therefore, enhance tissue repair. OBJECTIVE： To evaluate the efficacy of continuous passive joint motion following total knee replacement. METHODS： Totally 48 patients, who underwent artificial total knee arthroplasty at the Department of Orthopedics, Center Hospital of Minhang District, Shanghai Ruikang Hospital Group and Department of Rehabilitation Medicine, 309th Hospital of Chinese PLA between December 2007 and October 2009 were selected. The patients were randomly divided into the experimental and control groups, with 24 cases in each group. The isometric contraction of qudraceps muscles, combined with physical agent assistant, was performed prior to total knee replacement. Patients in the experimental group was received continuous passive joint motion training at day 2 after operation, with 5°-10°increasing per day. Patients in the control group were treated with conventional methods. The knee functional score, and visual analog scale （VAS） was performed to evaluate knee functions and pains, in addition, perimeter between two legs, and range of motion were measured. RESULTS AND CONCLUSION： The knee functional score, VAS, perimeter between two legs, and range of motion were similar prior to and after total knee replacement （P 0.05）. Compared to the control group, the knee functional score of the experimental group was dramatically increased at days 3 and weeks 2 after operation （P 0.01）, the VAS and perimeter between two legs were significantly declined （P 0.01）, the range of motion was obvious improved after replacement, with greater excellent rate （P 0.01）. There was no deep venous thrombosis or infections. The results demonstrated that early rehabilitation following knee replacement is conductive to easing pain, eliminating swelling, and enhancing knee stability.