关节松动术后加压冷疗对预防异位骨化的作用

Effect of Pressurizing Cryotherapy on the Prevention of Heterotopic Ossification After Joint Mobilization Technique

目的验证肘关节松动术后加压冷疗是否能预防异位骨化。方法选取2014年9月到2015年11月间于四川省医学科学院·四川省人民医院就诊并诊断为"肘关节骨折术后关节僵硬",但不伴异位骨化的患者,共72例,随机分为两组,每组36例。加压冷疗组于每次关节松动术后予持续加压冷疗30min,其余干预措施两组相同,比较两组异位骨化发生率(随访6个月),以及术后60min VAS疼痛评分、肘关节肿胀值,疗程结束后Mayo肘关节评分、评级等指标。结果在随访6个月内,对照组7例发生异位骨化,发生率19.4%;而加压冷疗组没有出现异位骨化,两组比较差异具有统计学意义(2=7.753,P=0.005)。治疗结束后,两组关节僵硬Mayo评级均明显提高,其中加压冷疗组优22例、良14例,对照组优16例、良13例、差7例,差异具有统计学意义(2=7.984,P=0.019)。治疗期间,术后1h肘关节肿胀与疼痛评分比较,差异具有统计学意义(P<0.05)。结论肘关节松动术后进行30min加压冷疗,有助于预防异位骨化,改善肘关节僵硬预后。

Objective To determine whether the pressurizing cryotherapy prevents the heterotopic ossification after joint mobilization technique. Methods A total of 72 patients diagnosed with joint stiffness after elbow fracture surgery and without heterotopic ossification in Sichuan Provincial People's Hospital from September of 2014 to November of 2015 were selected and divided randomly into two groups with 36 cases in each group. All the patients was given the same intervention measures, while the pressurizing cryotherapy group received the continuous pressurizing cryotherapy for 30 minutes after each joint mobilization. The two groups were compared in the indicators including the incidence of heterotopic ossification during 6 months of follow-ups, the VAS pain score and the swelling value of elbow joint at 60 minutes after joint mobilization technique, and the Mayo elbow score and rating at the end of treatment. Results There were 7 cases with heterotopic ossification in the control group which accounted for 19.4% and no cases with heterotopic ossification in the pressurizing cryotherapy group during 6 months of follow-ups, and the differences were statistically significant (χ^2 =7.753, P =0.005). The Mayo rating were significantly improved in both groups at the end of treatment. There were 22 cases rated as excellent and 14 cases as good in the pressurizing cryotherapy group while there were 16 cases rated as excellent, 13 cases as good and 7 cases as poor in the control group, and the differences were statistically significant (χ^2 =7.984, P =0.019). The VAS pain score and swelling value of elbow joint at 60 minutes after joint mobilization technique were also statistically different between the two groups. Conclusion The 30-minute pressurizing cryotherapy after joint mobilization technique is helpful to prevent heterotopic ossification and improve the prognosis of elbow joint stiffness.