中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (13): 2349-2352.doi: 10.3969/j.issn.1673-8225.2010.13.018

• 人工假体 artificial prosthesis • 上一篇    下一篇

膝关节置换后持续关节被动运动的速度因素：治疗组与对照组之差异

李小六   

  1. 上海市闵行区中心医院康复医学科，上海市 201100
  • 出版日期:2010-03-26 发布日期:2010-03-26
  • 作者简介:李小六，男，1976年生，河南省博爱县人，汉族，2004年华中科技大学毕业，主治医师，主要从事骨科关节康复研究。 lihang64@sina.com

Velocity factor of continuous passive motion following knee replacement: Differences between treatment and control groups

Li Xiao-liu   

  1. Department of Rehabilitation Medicine, Minhang Central Hospital, Shanghai   201100, China
  • Online:2010-03-26 Published:2010-03-26
  • About author:Li Xiao-liu, Attending physician, Department of Rehabilitation Medicine, Minhang Central Hospital, Shanghai 201100, China lihang64@sina.com

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摘要：

背景：目前采用持续被动运动治疗仪治疗全膝关节置换后关节僵硬和挛缩在骨科领域得到了广泛应用。进行持续被动运动时，速度的快慢很少引人关注，查阅国内外文献尚未找到相关报道。
目的：观察膝关节置换后持续被动运动的速度对关节功能恢复的影响。
方法：选择2007-12/2009-08上海瑞金医院集团闵行区中心医院骨科进行人工全膝关节置换的患者60例，根据就诊顺序分为2组，治疗组与对照组各30例，治疗组在开始时采取持续被动运动机最大速度的1/2，逐步由2/3过渡到最大速度治疗，初次活动范围为0°~45°，每天连续使用2 h，每次治疗按每5~15 min增加1°，每天增加活动范围为10°，出院前所有患者达到90°，次日以前1 d治疗结束后的最大角度为起点，再循序渐进增加。对照组根据患者舒适情况确定持续被动运动的速度。于人工全膝关节置换后使用持续被动运动机于治疗后第1，5天进行膝关节HSS评分及日常生活活动Barthel指数评定；治疗后第1，3，5天的同一时间分别测定患肢疼痛目测类比评分。
结果与结论：持续被动运动治疗后两组患肢疼痛目测类比评分均明显下降，在治疗后的第1天和第3天，治疗组的患肢疼痛目测类比评分显著低于对照组(P < 0.01)，治疗后的第5天两组差异无显著性意义(P > 0.05)。治疗后第5天治疗组HSS评分显著高于对照组(P < 0.01)，Barthel指数显著低于对照组(P < 0.01)。出院前膝关节活动度优率治疗组明显高于对照组。提示慢速开始循序渐进增加持续被动运动比按患者的意愿选择运动速度早期镇痛快，有助于日常活动能力的提高和膝关节稳定性的增强。

关键词: 人工全膝关节, 置换, 持续被动运动, 速度, 镇痛, 膝关节假体

Abstract:

BACKGROUND: At present, continuous passive motion therapeutic instrument for treatment of joint stiffness and contracture following total knee replacement has been widely applied in orthopedics field. The speed is seldom paid attention during continuous passive motion, and there are no relevant reports.
OBJECTIVE: To explore the effects of continuous passive motion speed on postoperative joint functional rehabilitation following knee replacement.
METHODS: A total of 60 patients undergoing artificial total knee replacement were selected at the Department of Orthopaedics, Minhang Central Hospital, Shanghai Ruijin Hospital Group from December 2007 to August 2009. The subjects were assigned to treatment and control groups (n = 30). The treatment group taken at the beginning of continuous passive motion machine maximum speed of 1/2 gradually from 2/3 of the transition to a maximum speed of treatment, the initial scope of activities for the 0°-45°, a day continuous use of 2 hours. Each treatment increased 5-15 minutes per 1°, range of activities every day for 10°, all patients prior to discharge to reach 90°. In the next day, the biggest point of view at day 1 of the end of treatment served as a starting point, and then a gradual increase. In the control group, velocity of continuous passive motion was determined in accordance with patient comfort. Continuous passive motion machine was used following artificial knee replacement to assess knee Hospital for Special Surgery (HSS) and activities of daily living Barthel index at 1 and 5 days following treatment. Affected limb underwent visual analogue scale (VAS) was detected at the same time at 1, 3 and 5 days following treatment.
RESULTS AND CONCLUSION: VAS of affected limb was significantly decreased in both groups following continuous passive motion treatment. At 1 and 3 days following treatment, VAS was significantly lower in the treatment group compared with the control group (P < 0.01). No significant difference was determined between both groups at day 5 (P > 0.05). HSS was significantly greater in the treatment group compared with the control group at day 5, whereas Barthel index was significantly lower in the treatment group than in the control group (P < 0.01). Efficacy rate of knee joint range of motion was significantly greater in the treatment group compared with the control group before discharge. Above-mentioned results indicated that slow start to increase progressively continuous passive motion campaigns will obtain early rapid analgesia compared with the choices according to the patients’ wills, resulting in improving the ability of daily activities and knee stability enhancement.

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