膝关节骨折患者康复模式的前瞻性多中心研究

A prospective multicenter study on the rehabilitation patterns for post-surgery patients with knee fractures

目的探讨膝关节骨折术后采用不同康复模式的治疗效果,提出适宜的膝关节骨折术后早期康复模式。方法纳入9家医院因膝关节骨折进行手术治疗后的279例患者作为研究对象,分为对照组和观察组。对照组采用现行骨科康复模式,观察组采用骨科康复一体化模式进行术后康复。分别在术后5天、12周、24周行视觉模拟评分(visual analague scale,VAS)、关节活动度评定;术后12周、24周行HSS(hospital for special surgery)功能和Berg平衡量表评定。结果膝关节骨折患者VAS评分观察组术后5天(4.35±3.17)分,术后12周(1.07±1.17)分,术后24周(0.45±0.78)分与对照组术后5天(4.05±2.03)分,术后12周(1.35±1.44)分,术后24周(0.58±0.99)分,差异无统计学意义(P>0.05)。Berg评分观察组术后12周(46.62±9.08)分,术后24周(53.78±4.90)分,对照组术后12周(43.27±12.35)分,术后24周(52.44±6.40)分,差异无统计学意义(P>0.05)。观察组膝关节主动屈曲活动度术后5天(45.16±32.33)°,术后12周(115.23±18.07)°,均优于对照组术后5天(30.36±32.15)°,术后12周(109.71±25.31)°(P=0.006,P=0.041),术后24周两组差异无统计学意义;膝关节主动伸直活动度观察组术后5天(1.50±4.67)°,术后12周(2.01±4.34)°,术后24周(1.06±3.64)°,对照组术后5天(1.14±5.66)°,术后12周(2.08±5.26)°,术后24周(1.03±4.10)°,差异无统计学意义(P>0.05);HSS评分观察组术后12周(73.52±14.46)分,术后24周(91.35±9.94)分,对照组术后12周(71.14±14.15)分,术后24周(90.11±10.24)分,差异无统计学意义(P>0.05),HSS"功能"维度观察组术后12周(16.12±5.26)分,显著优于对照组(13.88±5.40)分(P=0.003)。结论骨科康复一体化模式不增加膝关节骨折术后患者的疼痛,可更好地改善膝关节骨折患者术后功能指标,适合作为膝关节骨折术后早期康复模式。

Objective To evaluate the outcomes of different rehabilitation patterns for patients who have undergone a surgery after the knee fracture, and to put forward a suitable rehabilitation pattern for post-surgery patients with knee fractures. Methods A total of 279 cases who received knee surgery after the fracture in 9 hospitals in Beijing were divided into two groups：（ 1） the control group： received routine orthopedic rehabilitation;（ 2） the observation group： received post-surgery rehabilitation in team approach. Visual analogue scale（ VAS） and range of motion（ ROM） were assessed 5 days, 12 weeks and 24 weeks after the surgery. The hospital for special surgery score（ HSS） and Berg balance scale were assessed 12 weeks and 24 weeks after the surgery. Results There were no significant differences in VAS [ the observation group at 3- 5 days, 12 weeks and 24 weeks after the surgery were（ 4.35 ± 3.17）,（ 1.07 ± 1.17） and（ 0.45 ± 0.78）; the control group at 3- 5 days, 12 weeks and 24 weeks after the surgery were（ 4.05 ± 2.03）,（ 1.35 ± 1.44） and（ 0.58 ± 0.99） ] and Berg balance scale [ the observation group at 12 weeks and 24 weeks after the surgery were（ 46.62 ± 9.08） and（ 53.78 ± 4.90）; the control group at 12 weeks and 24 weeks after surgery were（ 43.27 ± 12.35） and（ 52.44 ± 6.40） ] between the two groups（ P〈0.05）. The observation group showed better flexion ROM at 5 days [ the observation group（ 45.16 ± 32.33） °, the control group（ 30.36 ± 32.15） ° ] and 12 weeks [ the observation group（ 115.23 ± 18.07） °, the control group（ 109.71 ± 25.31） ° ] after the surgery（ P = 0.006, P = 0.041）, and no statistical significance existed 24 weeks postoperatively. The knee extension ROM in the observation group at 5 days, 12 weeks and 24 weeks were（ 1.50 ± 4.67） °,（ 2.01 ± 4.34） °, and（ 1.06 ± 3.64） °, while（ 1.50 ± 4.67） °,（ 2.01 ± 4.34） °, and（ 1.06 ± 3.64） ° in the control group without statistical significance（ P〈0.05）. The HSS in the observation group at 12 weeks and 24 weeks were（ 73.52 ± 14.46） points and（ 91.35 ± 9.94） points, while（ 71.14 ± 14.15） points and（ 90.11 ± 10.24） points in the control group without statistical significance（ P〈0.05）. HSS（ function） in the observation group at 12 weeks（ 16.12 ± 5.26） points was better than the control group（ 13.88 ± 5.40） points after the surgery（ P = 0.003）. Conclusions The rehabilitation in team approach improves knee functions better than common orthopedic rehabilitation. It is suitable for early post-surgery rehabilitation after the knee fracture.