胫骨平台骨折术后早期持续被动运动对膝关节内炎症及功能的影响

Effect of early continuous passive motion on intra-articular inflammation after operation of tibial plateau fracture

目的探讨胫骨平台骨折术后早期持续被动运动对膝关节内炎症反应及膝关节功能的影响。方法纳入自2015-10—2017-03行锁定钢板内固定治疗的13例SchatzkerⅠ型胫骨平台骨折,对照组(6例)术后常规物理治疗,观察组(7例)术后第1天开始连续6 d持续被动训练。比较2组术后第7天疼痛VAS评分、膝关节活动度,术后第7天关节腔积液中IL-1β、TNF-α、IL-1Ra、IL-10、IL-6浓度,以及术后3个月膝关节功能HSS评分。结果 13例均获得3个月以上随访。观察组术后第7天疼痛VAS评分明显低于对照组,且膝关节活动度明显高于对照组,差异有统计学意义(P<0.05)。术后3个月观察组膝关节功能HSS评分明显高于对照组,差异有统计学意义(P<0.05)。术后第7天观察组关节腔积液IL-1β、TNF-α浓度降低,而IL-1Ra、IL-10、IL-6浓度升高,差异有统计学意义(P<0.05)。结论 SchatzkerⅠ型胫骨平台骨折术后患者进行持续被动训练可促进关节内炎症消退,减轻疼痛,有利于膝关节功能恢复。

Objective To investigate the effect of early continuous passive motion on intra-articular inflammation after operation of tibial plateau fracture.Methods From October 2015 to March 2017,13 patients with tibial plateau fracture（Schatzker type I）underwent internal fixation with locking plate.The control group（6 cases）was given postoperative routine physical therapy while from the 1 d after operation,the observation group（7 cases）received 6 d continuous passive motion.VAS scores,knee joint activity and the levels of the IL-1β,TNF-α,IL-1Ra,IL-10,IL-6 in articular effusion were compared between the two groups on the seventh day after operation,and the knee joint function were evaluated by HSS 3 months after operation.Results All patients were followed up for over 3 months.The VAS score in the observation group was significantly lower than that in the control group on the seventh day after operation,but the knee joint activity was significantly higher than that in the control group（P 〈0.05）.The HSS score of the knee joint function in the observation group was significantly higher than that in the control group at 3 months after the operation,and the difference was statistically significant（P 〈0.05）.Seven days after operation,the levels of IL-1β and TNF-α in the articular effusion in the observation group decreased,but the levels of IL-1Ra,IL-10 and IL-6 increased,and the difference was statistically significant（P 〈0.05）.Conclusion Early continuous passive motion after operation of Schatzker type I tibial plateau fracture can improve vanishing of the inflammation,relieve pain,and be beneficial to the recovery of the knee joint function.