Schatzker Ⅳ~Ⅴ型胫骨平台骨折术后持续被动运动促进患者膝关节功能康复的临床观察

Clinical observation of continuous passive motion to promote the recovery of knee function in patients with Ⅳ-Ⅴ tibial plateau fracture

目的观察并探讨持续被动运动(continuous passive motion,CPM)对Schatzker IV^V型胫骨平台骨折术后膝关节功能康复的影响。方法将2014年1月至2015年12月收治的108例研究对象按照EXCEL产生的随机数字分为研究组(55例)和对照组(53例),在手术复位并内固定后,对照组予主动肌力训练,研究组在对照组基础上予4~5周CPM,术后1个月、3个月测量膝关节最大活动度,术后3个月采用特种外科医院(hospital for special surgery,HSS)评分评价膝关节功能。结果术后患者均获得随访,两组术后1天、1个月、3个月伸膝活动度及术后1天屈膝活动度差异均无统计学意义(P>0.05),研究组术后1个月[(92.4±10.8)°vs.(84.5±12.0)°]、3个月[(118.6±12.4)°vs.(112.3±10.5)°]屈膝活动度均显著大于对照组,差异有统计学意义(P<0.05)。两组术后1天HSS评分差异无统计学意义(P>0.05);研究组术后3个月HSS评分[(88.2±4.2) vs.(84.0±5.0)]及疼痛[(26.5±3.2) vs.(24.9±3.4)]、功能[(19.0±1.7) vs.(18.2±1.9)]、活动度[(15.5±1.5) vs.(14.6±1.8)]、肌力[(9.4±1.1) vs.(8.8±1.0)]评分均显著高于对照组,差异有统计学意义(P<0.05)。结论 Schatzker IV^V型胫骨平台骨折术后在主动肌力训练基础上给予CPM有助于促进膝关节功能的康复。

Objective To investigate the effects of continuous passive motion（ CPM） on knee function rehabilitation of Schatzker IV-V tibial plateau fracture. Methods From January 2014 to December 2015, 108 patients were randomly divided into the study group（ n = 55） and control group（ n = 53）. After surgical reduction and internal fixation, the control group was given active strength training, while the study group was added with 4 to 5 weeks＇ CPM training. Maximum knee flexion 1 day, 1 month, 3 months post-operation were evaluated. Hospital for special surgery（ HSS） score was introduced to evaluate the knee function 3 months postoperatively. Results All patients were followed up. Between the 2 groups, no significant differences were found on the maximum extensor degree 1 day, 1 month, 3 months post-operation, as well as maximum knelt down degree 1 day after operation（ P〈0.05）. The maximum knelt down degree 1 month [（ 92.4 ± 10.8） ° vs.（ 84.5 ± 12.0） ° ], 3 months [（ 118.6 ± 12.4） ° vs.（ 112.3 ± 10.5） ° ] postoperatively in the study group were significantly higher than that in the control group（ P〈0.05）. There were no significant differences in 1 day HSS score after operation between the 2 groups（ P〈0.05）. In the study group 3 months postoperatively, HSS score [（ 88.2 ± 4.2） vs.（ 84.0 ± 5.0） ], pain score [（ 26.5 ± 3.2） vs.（ 24.9 ± 3.4） ], function score [（ 19.0 ± 1.7） vs.（ 18.2 ± 1.9） ], flexion score [（ 15.5 ± 1.5） vs.（ 14.6 ± 1.8） ], and muscle strength [（ 9.4 ± 1.1） vs.（ 8.8 ± 1.0） ] were all significantly higher than that in the control group（ P〈0.05）. Conclusions Based on active muscle training after operation, CPM added can help to promote the recovery of knee function for patients with IV-V tibial plateau fracture.