关节镜辅助复位内固定结合术后CPM治疗胫骨平台骨折的临床效果观察

An Observation of the Clinical Efficacy of the CPM Training After Arthroscopically-assisted Reduction Operation in the Treatment of Tibial Plateau Fracture

目的探讨关节镜辅助复位内固定结合术后持续被动运动(continuous passive motion、CPM)治疗胫骨平台骨折的临床效果。方法回顾分析2012年1月至2014年1月成都市第七人民医院骨科收治的75例胫骨平台骨折手术患者资料,所有患者均行关节镜辅助复位内固定术,以主动膝关节训练结合CPM治疗的患者为观察组(39例),以单纯主动膝关节运动训练治疗的患者为对照组(36例)。比较两组患者术后第2、4、6和12周患膝关节的伸膝活动度和屈膝活动度,Rasmussen功能评分。结果两组患者伸膝活动度比较,第12周观察组伸膝活动度高于对照组,差异有统计学意义(P<0.05);观察组患者术后患膝关节的屈膝活动度均高于对照组,除术后第4周外,两组患者患膝关节的屈膝活动度比较差异有统计学意义(P<0.05)。两组患者Rasmussen功能评分优良率比较,从各个时间点看,除基线水平及术后2周时两组评分差异无统计学意义外(χ~2=0.457,P=0.928),其余各时间点观察组优良率均较高(P<0.05),差异有统计学意义(F=67.886,P<0.001);各时间点优良率趋势均随时间逐渐上升。结论关节镜辅助复位内固定结合术后CPM治疗胫骨平台骨折可提高临床疗效,利于患者进行早期康复功能锻炼,改善患者膝关节功能。

Objective To investigate the clinical efficacy of the continuous passive motion（CPM）training after arthroscopically-assisted reduction operation in the treatment of the tibial plateau fracture.Methods The clinical data of 75 patients with tibial plateau fracture treated in the The Seventh People＇s Hospital of Chengdu from January of 2012 to January of 2014 were reviewed and analyzed retrospectively.After all the patients underwent the arthroscopically-assisted reduction operation,the 39 patients of the observation group received postoperative CPM treatment,while the other 36 patients of the control group were treated with the active exercise training.The comparisons were made after the operation between the two groups in the degrees of knee extensor activity and knee flexion and the Rasmussen function score at the 2^nd,4^th,6^th and 12^th week respectively.Results The degrees of extensor activity in the observation group were higher than those in the control group at the 2^nd,4^th and 6^th week（P〈0.05）,but that of the observation group was significantly higher than that of the control group at the 12^th week（P〈0.05）.The degree of knee flexion in the observation group were significantly higher than those in the control group at all the weeks（P〈0.05）except for at the 4^th week（P〈0.05）.The excellence rates of Rasmussen function scores in the observation group were significantly higher at all the weeks（F=67.886,P〈0.001）except for at baseline and at the 2^nd week（χ^2=0.457,P=0.928）than those in the control group,and the excellence rates tend to be higher as time passes.Conclusion CPM after arthroscopically-assisted reduction operation can improve the clinical efficacy in the treatment of tibial plateau fractures,which can promote patients＇ early rehabilitation exercises and improve their knee function.