全膝关节置换后局部加压冷疗结合CPM功能锻炼对早期关节功能恢复的影响

Impact of local compression cryotherapy combined with continuous passive motion on the early functional recovery after total knee arthroplasty

背景:早期康复训练有利于全膝关节置换后关节功能的恢复;而术后冰敷能部分缓解全膝关节置换后的疼痛,增强早期康复训练的有效性。目的:探讨局部加压冷疗结合CPM功能锻炼对全膝关节置换后早期功能障碍及关节功能的影响。方法:选择2013年2月至2015年2月行全膝关节置换治疗的106例患者为研究对象,根据入院时间按照单双号随机分为观察组和对照组,每组53例。对照组术后进行CPM功能锻炼,观察组在术后给予局部加压冷疗结合CPM功能锻炼。比较2组患者膝关节肿胀程度、疼痛目测类比评分、美国特种外科医院膝关节功能评分及临床疗效。结果与结论:(1)术后24,48 h,观察组目测类比评分、肿胀值均明显低于对照组(P<0.01);(2)术后2周,2组除肌力外,其余均明显改善(P<0.05-0.01),观察组美国特种外科医院膝关节功能评分系统中疼痛、功能、活动度、稳定性维度和总分均明显高于对照组,减分项目评分明显低于对照组(P<0.05);(3)随访6个月,观察组膝关节功能优良率87%明显高于对照组70%(P<0.05);(4)结果表明,局部加压冷疗结合CPM功能锻炼有助于缓解全膝关节置换后的早期疼痛及肿胀程度,促进膝关节功能恢复。

BACKGROUND： Early rehabilitation training is beneficial for the functional recovery after total knee arthroplasty （TKA）, and its effectiveness can be enhanced through ice compression that can partly alleviate the postoperative pain. OBJECTIVE： To explore the effect of local compression cryotherapy combined with continuous passive motion on the early functional recovery after TKA.METHODS： 106 patients undergoing TKA from February 2013 to February 2015 were enrolled, and randomly divided into observation and control groups （n=53 per group） according to the admission time and simple sampling. The control group was given continuous passive motion, while the observation group was subjected to local compression cryotherapy combined with continuous passive motion. The swelling degree, visual analogue scale scores, hospital for special knee surgery scores, and efficacy were compared between two aroups.RESULTS AND CONCLUSION： （1） The swelling degree and visual analogue scale scores in the observation group were significantly lower than those in the control group at 24 and 48 hours after surgery （P 〈 0.01）. （2） At 2 weeks after surgery, all indicators except muscle strength were significantly improved in both two groups （P 〈 0.05-0.01）; the pain, function, activity, stability and total scores of hospital for special surgery knee scores in the observation group were significantly higher than those in the control group, and the reduction project scores were significantly lower than those in the control group （P 〈 0.05）. （3） After followed up for 6 months, the excellent rate of knee joint function in the observation group was significantly higher than that in the control group （87% versus 70%, P 〈 0.05）. （4） These results suggest that local compression cryotherapy combined with continuous passive motion can improve early pain and swelling degree, and promote the functional recovery after TKA.