全膝关节置换术后持续被动活动的疗效:一项基于26个随机对照试验的系统评价

Evaluation of Effectiveness of Continous Passive Motion after Total Knee Arthroplasty:A Meta-analysis of Randomized Controlled Trails

目的评价持续被动活动(CPM)对全膝关节置换术(TKR)后肢体功能改善的作用。方法计算机检索Cochrane Database of Systematic Reviews、MEDLINE、EMBASE、PEDro、中国知网(CNKI)、维普数据库(VIP)中关于CPM对改善TKR术后患者肢体功能的随机对照试验(RCT),同时筛检纳入文献的参考文献。文献检索起止时间均为从建库到2010年7月。由3名研究人员根据Cochrane协作网推荐的单项临床试验真实性评估方法,对文献质量进行严格评价和资料提取,对符合质量标准的RCT进行Meta分析。结果共纳入26个RCT。Meta分析结果显示:与常规的康复治疗方法(例如肌力等长或等张训练、功能训练、步态训练、关节松动术、冷疗、湿热等)相比,CPM能够在短期内更好地改善术后患者主动屈膝关节活动度[WMD=3.96,95%CI(0.14,7.78),P=0.04];被动屈膝关节活动度[WMD=2.36,95%CI(0.73,3.98),P=0.005]和术后膝关节肿胀[WMD=-1.60,95%CI(-2.44,-0.76),P<0.001];能够有效缓解术后关节疼痛[WMD=-0.77,95%CI(-1.16,-0.39),P<0.001][WMD=-1.54,95%CI(-2.47,-0.62),P=0.001]。但还不能认为:CPM比常规康复治疗方法能更好更快地改善术后患者的主、被动伸膝关节活动度,提高股四头肌肌力,以及缩短住院时间。结论 TKR术后早期开展CPM,可在短期内有效地改善患肢屈膝功能,消除关节肿胀,减轻疼痛。但仍需要开展大样本量、多中心、方法科学和规范的高质量RCT,以求进一步验证CPM的效果。

Objective To evaluate the effectivenes of continous passive motion（CPM） on limb function in patients after total knee arthroplasty.MethodsThe Cochrane Database of Systematic Reviews,MEDLINE,EMBASE,PEDro,CNKI and VIP were retrieved from the date of establishment of the databases to July,2010 to collect randomized controlled trials（RCTs）.The quality of RCTs was critically appraised and data were extracted by 4 reviewers independently.Meta-analysis was conducted for the eligible RCTs.Results26 RCTs were included.The result of Meta-analysis showed that CPM improved the range of motion（ROM） in active knee flexion and passive knee flexion,eliminate swelling in short term（〈6 weeks） and alleviate pain in short and medium term（less than 6 months）.CPM showed no significant difference in improving the ROM in active and passive knee extention and quadriceps strength,and shortening hospital stay.ConclusionThe patients carried out CPM training after total knee arthroplasty can effectively improve limb flexion function,eliminate joint swelling,and relieve pain in the short term.But more high-quality and largescale RCTs are needed.