持续被动运动初始角度对单侧全膝关节置换术后早期康复的影响  

Effect of initial angle of continuous passive motion on early rehabilitation after unilateral total knee arthroplasty

作　　者：曲宝君 薛慧[1] 苏昕[1] QU Baojun;XUE Hui;SU Xin(Department of Orthopedics,Qingdao Municipal Hospital,Qingdao,Shandong 266000,China)

机构地区：[1]青岛市市立医院骨科,山东青岛266000

出　　处：《安徽医药》2020年第7期1402-1406,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨持续被动运动(Continuous Passive Motion,CPM)初始角度对单侧全膝关节置换术后早期康复的影响。方法2017年8月至2019年6月采用简单随机法抽取青岛市市立医院关节科膝关节置换病人120例纳入研究,每组各40例,其中9例因不能依从治疗退出研究,根据研究方案将病人分为三组,三组病人术后CPM初始角度分别设定为20°(小角度组,40例),最大屈曲角-10°(耐受组,40例)和最大屈曲角(最大耐受组,31例),术后24 h后开始CPM康复锻炼,以NRS法评估每例病人疼痛情况,并进行统计分析,术后第3、7 d测量病人膝关节主动活动度(Active Range of Motion,AROM),对比三组病人膝关节功能恢复情况,评估三种方法的近期疗效,并对各组病人伸膝迟滞和下肢深静脉血栓等不良事件发生率的差异进行比较。结果最大耐受组依从率为77.5%,其余两组均完全依从。术后3 d,小角度组、耐受组、最大耐受组AROM分别为(43.41±9.87)°、(51.46±9.80)°、(57.73±10.62)°,两两比较均差异有统计学意义,术后7 d,最大耐受组(89.88±8.53)°与耐受组(88.60±8.34)°其AROM均大于小角度组(71.11±10.03)°,且差异有统计学意义,最大耐受组和耐受组术后7 d AROM差异无统计学意义。三组病人的伸膝迟滞和下肢深静脉血栓发生率无明显差异。术后2~4 d,最大耐受组疼痛评分>耐受组>小角度组,且差异有统计学意义;术后5~7 d,三组病人评分差异无统计学意义。结论运用CPM可以促进膝关节置换术后关节活动度的恢复,但康复需要一定的强度,推荐初始角度设定为最大耐受角度-10°,使CPM既能被病人依从,又能保证临床疗效。Objective To explore the effect of initial flexion of continuous passive motion(CPM)on early rehabilitation after total knee arthroplasty.MethodsFrom August 2017 to June 2019,120 patients with knee arthroplasty in Qingdao Municipal Hospital were randomly selected in this study,with 40 patients in each group.Nine patients incompatible with the treatment were excluded.All the patients were divided into three groups.The initial motion range of CPM for the three groups were set as 20°(the small flexion group),20°,the maximum flexion angle minus 10°(the medial group)and the maximum flexion angle(the maximum flexion group),respectively.CPM exercise was started 24 hours after operation.The pain of each patient was assessed by NRS,and the AROM of knee was measured on the 3 rd and 7 th day after operation.We estimated knee function and analyzed the difference of incidence of adverse events such as deep venous thrombosis among the three groups.ResultsThe compliance rate of the maximal flexion group was 77.5%,and the other two groups fully adhered to the treatment.The AROM of the three groups on the 3 rd day after operation were(43.41±9.87)°,(51.46±9.80)°and(57.73±10.62)°,respectively,with significant difference among the three groups.On the 7 th day,the AROM of the maximum flexion group(89.88±8.53)°and the medial flexion group(88.60±8.34)°was significantly higher than that of the small flexion group(71.11±10.03)°,but there was no significant difference between maximum flexion group and median group.Also,there was no significant difference in knee extension delay and deep venous thrombosis among these groups.From the 2 nd day to the 4 th day after operation,the NRS score of maximum flexion group was higher than that of the median and small group,and the difference was statistically significant.From the 5 th to 7 th day after operation,there was no significant difference in patients’scores among the three groups.ConclusionCPM can promote the rehabilitation of joint range of motion after total knee arthroplas

关 键 词：关节成形术 置换 膝/康复 运动疗法 持续被动性/方法 活动范围 关节 运动活动 早日下床活动 静脉血栓形成 膝关节主动活动度 

分 类 号：R687.4[医药卫生—骨科学]