踝关节内固定术后即时关节被动活动评估

Evaluation of Immediate Continuous Passive Motion after Ankle Fracture Internal Fixation

目的评估双踝、三踝骨折伴移位术后立即给予被动关节功能锻炼的作用。方法收治44例双踝、三踝骨折伴移位患者,随机分为试验组和对照组各22例。两组患者均获得解剖复位、坚强内固定,试验组术后即给予持续被动活动(CPM)3周;对照组给予石膏或者支具外固定3周。结果所有患者均按照AO关节评估系统(AOFAS)评估疗效,实验组平均得分(95.7±3.42)分(87～100分),其中2例有骨性关节炎的征象;对照组平均得分(88.0±10.60)分(68～100分),6例有踝关节骨性关节炎的征象,其中1例症状较重。结论 CPM术后关节持续被动锻炼是恢复踝关节功能的一个有效途径,可以应用于骨折复位和坚强内固定的踝关节骨折,使踝关节快速恢复正常活动度,明显减少了术后发生早期关节退行性改变的危险性。

Objective To evaluate the effect of immediate postoperative continuous passive motion in the management of displaced bimalleolar and trimalleolar fractures treated surgically.Methods Two series of 22 patients each, who had had a Weber type A, B or C ankle fracture treated surgically, were followed up at least 4 years after the injury. In the first series, immediately after surgery, a continuous passive motion machine was applied to the operated ankle for 3 weeks, whereas in the second series, after surgery a plaster splint or a plaster cast was applied for 3 weeks.Results At follow-up, all patients were evaluated clinically and radiographically using the AOFAS Ankle Hindfoot Score System. The average final score for the first series of patients was （95.7±3.42） points （range 87-100 points）. Of this series, at radiographic examination, in two patients minor signs of osteoarthritis of the ankle joint were observed. The average final score for the second series was （88.0± 10.60） points （range 68-100 points）. At radiographic examination, in six patients minor signs of osteoarthritis of the ankle joint were observed, whereas in another one the osteoarthritis was severe.Conclusion Continuous passive motion started immediately after surgery seems to be an effective method both for allowing complete and quick recovery of the range of motion of the ankle and for reducing the risk of early degenerative joint disease. Immediate passive ankle motion can be applied only after adequate reduction and stable internal fixation.