连续性被动运动训练对老年全膝关节置换术后下肢运动功能及炎症因子水平的影响

Effect of Continuous Passive Motion Training on Lower Extremity Motor Function and Inflammatory Factor Level in the Elderly after Total Knee Arthroplasty

目的:探讨连续性被动运动训练(CPM)对老年全膝关节置换术(TKA)后下肢运动功能及炎症因子水平的影响。方法:82例老年TKA患者随机分为对照组(41例)和观察组(41例)。对照组采用常规康复措施,观察组在对照组基础上采用CPM治疗。于训练前1d,训练后第1d、3d、7d及14d记录两组患者肿胀程度和膝关节功能(HSS)功能评分。采用应用酶联免疫吸附测定法(ELISA)检测患者训练前后血清白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)及血清肿瘤坏死因子-α(TNF-α)水平。随访100d,记录两组患者不良反应发生情况,并采用Kaplan-Meier法评价患者首次独立活动情况。结果:训练后第3d,观察组患者肿胀程度明显低于对照组(P<0.05),而两组HSS功能评分差异无统计学意义(P>0.05);训练后第7d及14 d,观察组患者肿胀程度明显低于对照组(P<0.05),而HSS功能评分明显高于对照组(P<0.05)。训练后3d、7d及14d,观察组患者血清IL-6、IL-1β及TNF-α表达水平低于对照组(P<0.05)。观察组患者并发症发生率明显低于对照组,差异有统计学意义(P<0.05)。Kaplan-Meier法分析发现观察组首次独立活动平均时间69d,短于对照组82.5d,差异有统计学意义(P<0.05)。结论:CPM对改善老年患者肿胀程度和膝关节功能有明显优势,并有助于减少并发症的发生,其机制可能与降低患者炎症反应有关。

Objective: To explore the effect of continuous passive motion training(CPM) on the lower extremity motor function and inflammatory factors in the elderly after total knee arthroplasty(TKA). Methods: 82 elderly patients with TKA were randomly divided into control group(41 cases) and observation group(41 cases). The control group was treated with routine rehabilitation measures, and the observation group was treated with CPM on the basis of the control group.The swelling degree and the score of knee joint function(HSS) were recorded on the 1 d before training, 1 d, 3 d, 7 d and 14 d after training. The serum levels of IL-6, IL-1β and TNF-α were measured by enzyme-linked immunosorbent assay(ELISA) before and after training. After 100 d follow-up, adverse reactions of the two groups were recorded, and Kaplan-Meier method was used to evaluate the first independent activity of the patients. Results: On the 1 d after training, the swelling degree of the patients in the observation group was significantly lower than that in the control group(P<0.05),but there was no significant difference in HSS function score between the two groups(P>0.05);on the 7 d and 14 d after training, the swelling degree of the patients in the observation group was significantly lower than that in the control group(P<0.05), while the HSS function score was significantly higher than that in the control group(P<0.05). The expression levels of IL-6, IL-1β and TNF-α on the 3 d,7 d and 14 d after training in the observation group were lower than those in the control group(P<0.05). The incidence of complications in the observation group was significantly lower than that in the control group(P<0.05). Kaplan-Meier analysis showed that the average time of the first independent activity in the observation group was 69 d, shorter than 82.5 d in the control group, the difference was statistically significant(P<0.05). Conclusion: CPM has obvious advantages in improving the degree of swelling and knee joint function of the elderly patients, and helps to reduce the occurrence of complications, and its mechanism may be related to reducing the inflammatory response of the patients.