双髁胫骨平台骨折术后的康复时机分析

Starting Time of Rehabilitation on Bicondylar Tibial Plateau Fractures

目的探讨双髁胫骨平台骨折术后早期康复的方法及临床治疗效果。方法回顾性分析66例双髁胫骨平台骨折患者,依据术后开始康复的时机分为早期康复组(30例)和恢复期康复组(36例)。通过测定X线片胫骨平台内翻角及胫骨平台后倾角、关节活动度检查及美国特种外科医院(HSS)膝关节功能评分进行比较。结果两组末次随访与术后X线片胫骨平台内翻角及后倾角平均值的差异无统计学意义(P>0.05);两组HSS评分、膝关节屈曲和伸直关节活动度(ROM)均值比较,差异均有统计学意义(P<0.01或0.05);康复开始时间与总治疗次数呈显著正相关(P<0.01),与膝关节屈曲ROM和HSS评分呈显著负相关(P<0.01)。结论康复介入时机与双髁胫骨平台骨折术后膝关节功能恢复效果相关性显著,术后早期康复训练可有效提高患者预后功能。

Objective To investigate methods of early postoperative rehabilitation and its effects on patients with bicondylar tibial plateau fracture treated by modified dual plating.Methods 66 patients with bicondylar tibial plateau fracture from Tianjin Hospital were divided into 2 groups according to the starting time for postoperative rehabilitation： early rehabilitation group（n=30）,convalescents rehabilitation group（n=36）.The two groups had the same treatment since the fourth week postoperative.Tibial plateau angle（TPA） and posterior slope angle（PA） of tibial plateau were measured to evaluate the stability of proximal tibial and knee alignment.The Hospital for Special Surgery（HSS） score system and knee joint range of motion（ROM） were used as the parameters for knee function.Results The mean value of TPA and PA had no significant changes,compared to the final follow-up and postoperative X-ray films（P〉0.05）;the differences between the two groups were statistically significant in the mean HSS score and mean value of knee flexion and extention ROM（P〈0.01 or 0.05）.There was significantly positive correlation between starting time and the total number of treatment was significant（P〈0.01）,while negative correlation with flexion ROM of knee joint and the HSS score（P〈0.01）.Conclusion The correlation between rehabilitation intervention timing and functional recovery for patients with bicondylar tibial plateau fracture treated by modified dual plating is significant,early individual and systematic rehabilitation therapy can effectively improve the prognosis features of patients.