CAJ | 학술논문

背景:膝关节置换后的早期康复治疗逐渐引起关注,进行持续被动关节运动的主要目的是恢复膝关节功能,防止关节僵硬,同时促进手术部位血液和关节滑液循环,从而加快组织修复.目的:评价人工全膝关节置换后持续被动关节运动的疗效.方法:选择2007-12/2009-10上海瑞金医院集团闵行中心医院骨科和解放军第三○九医院康复医学科进行人工全膝关节置换的48例患者,随机分为治疗组和对照组,24例,组.两组患者在进行全膝关节置换前,给予股四头肌等长收缩等训练,并辅助物理因子治疗.治疗组患者在全膝关节置换后第2天开始进行膝关节持续被动关节运动,1 h/d,每日运动范围以患者略感疼痛为宜,被动运动范围每日增加5°-10°.对照组患者全膝关节置换后抬高患肢30 cm,按骨科常规方法进行临床治疗.采用膝关节外科协会评分系统评价膝关节功能,采用目测类比评分法评定患肢疼痛,通过测量双下肢周径评定患肢肿胀程度,测量膝关节活动度的变化.结果与结论:全膝关节置换前,两组患者的膝关节功能评分、VAS患肢疼痛评分、双下肢周径、膝关节活动度均基本相似(P>0.05).与对照组比较,治疗组在置换后3 d及2周膝关节功能评分显著升高(P<0.01),置换后3 d VAS患肢疼痛评分及双下肢周径显著降低(P<0.01),置换后膝关节活动度明显改善,达优率显著升高(P<0.01).48例患者均无深静脉血栓形成、感染等并发症发生.结果提示早期持续被动关节运动有助于膝关节置换后疼痛的缓解、肿胀的消除以及膝关节稳定性的增强.
배경:슬관절치환후적조기강복치료축점인기관주,진행지속피동관절운동적주요목적시회복슬관절공능,방지관절강경,동시촉진수술부위혈액화관절활액순배,종이가쾌조직수복.목적:평개인공전슬관절치환후지속피동관절운동적료효.방법:선택2007-12/2009-10상해서금의원집단민행중심의원골과화해방군제삼○구의원강복의학과진행인공전슬관절치환적48례환자,수궤분위치료조화대조조,24례,조.량조환자재진행전슬관절치환전,급여고사두기등장수축등훈련,병보조물리인자치료.치료조환자재전슬관절치환후제2천개시진행슬관절지속피동관절운동,1 h/d,매일운동범위이환자략감동통위의,피동운동범위매일증가5°-10°.대조조환자전슬관절치환후태고환지30 cm,안골과상규방법진행림상치료.채용슬관절외과협회평분계통평개슬관절공능,채용목측류비평분법평정환지동통,통과측량쌍하지주경평정환지종창정도,측량슬관절활동도적변화.결과여결론:전슬관절치환전,량조환자적슬관절공능평분、VAS환지동통평분、쌍하지주경、슬관절활동도균기본상사(P>0.05).여대조조비교,치료조재치환후3 d급2주슬관절공능평분현저승고(P<0.01),치환후3 d VAS환지동통평분급쌍하지주경현저강저(P<0.01),치환후슬관절활동도명현개선,체우솔현저승고(P<0.01).48례환자균무심정맥혈전형성、감염등병발증발생.결과제시조기지속피동관절운동유조우슬관절치환후동통적완해、종창적소제이급슬관절은정성적증강.
BACKGROUND: Early rehabilitation following total knee replacement has arisen more attention. The aim of continuous passive joint motion is to recover knee function, prevent anchylosis, accelerate blood and synovia circulation, therefore, enhance tissue repair. OBJECTIVE: To evaluate the efficacy of continuous passive joint motion following total knee replacement. METHODS: Totally 48 patients, who underwent artificial total knee arthroplasty at the Department of Orthopedics, Center Hospital of Minhang District, Shanghai Ruikang Hospital Group and Department of Rehabilitation Medicine, 309~(th) Hospital of Chinese PLA between December 2007 and October 2009 were selected. The patients were randomly divided into the experimental and control groups, with 24 cases in each group. The isometric contraction of qudraceps muscles, combined with physical agent assistant, was performed prior to total knee replacement. Patients in the experimental group was received continuous passive joint motion training at day 2 after operation, with 5°-10°increasing per day. Patients in the control group were treated with conventional methods. The knee functional score, and visual analog scale (VAS) was performed to evaluate knee functions and pains, in addition, perimeter between two legs; and range of motion were measured. RESULTS AND CONCLUSION: The knee functional score, VAS, perimeter between two legs, and range of motion were similar prior to and after total knee replacement (P > 0.05). Compared to the control group, the knee functional score of the experimental group was dramatically increased at days 3 and weeks 2 after operation (P < 0.01), the VAS and perimeter between two legs were significantly declined (P < 0.01), the range of motion was obvious improved after replacement, with greater excellent rate (P < 0.01). There was no deep venous thrombosis or infections. The results demonstrated that early rehabilitation following knee replacement is conductive to easing pain, eliminating swelling, and enhancing knee stability.