全膝关节置换术后被动与主动活动康复的比较Comparison of passive versus active motion in early rehabilitation after total knee replacement
王军霞;
摘要(Abstract):
[目的]探讨全膝关节置换术后患者对被动与主动活动康复锻炼方式的心理接受程度及心理状态差异,并分析其对功能恢复的影响。[方法]本院2008年4月~2012年4月收治的单侧膝关节骨性关节炎患者151例,均采用单侧膝关节置换术;随机分为持续被动运动组(continuous passive motion,CPM)和自主训练组(active motion,AM)。比较两组患者年龄、性别、体重指数、手术时间、术后引流量、住院时间、对康复锻炼接受程度、美国特种外科医院膝关节评分(hospital for special surgery,HSS)、关节活动度、医院焦虑抑郁表(hospital anxiety and depression scale,HADS)等。[结果]两组在年龄、性别、体重指数、手术时间、术后引流量的差异无统计学意义(P>0.05)。CPM组平均住院时间为(5.25±0.98)d,AM组为(4.36±0.59)d,AM组平均住院时间比CPM组少(0.89±0.41)d,两组间差异有统计学意义(P<0.05)。CPM组中64%患者表示对CPM恐惧或勉强接受,而在AM组仅为32%(P<0.05)。CPM组平均HADS评分(9.40±3.70)分,而AM组平均HADS评分(6.20±3.10)分,AM组比CPM组少(3.20±0.70)分,两组间差异有统计学意义(P<0.05)。此外,AM组可明显缓解术后早期疼痛及肿胀指数,改善HSS评分及关节活动度(P<0.05),但远期效果差异无统计学意义(P<0.05)。[结论]"自主训练,护理辅助"的康复策略更容易被患者所接受,能早期改善关节功能、缓解局部肿胀及疼痛,是TKA术后早期功能康复训练的方法之一。
关键词(KeyWords): 膝关节置换;早期康复训练;被动活动;主动活动
基金项目(Foundation):
作者(Author): 王军霞;
Email:
DOI:
参考文献(References):
- [1]王志强,黄伟,梁熙,等.微创与传统入路对全膝关节置换术后早期股四头肌肌力的影响[J].中华骨科杂志,2013,33(12):1204-1211.
- [2]朱斌杰,陈哲峰,刘锋,等.同期和分期全膝关节置换术治疗双膝关节骨关节炎的安全性与疗效[J].中华骨科杂志,2014,34(6):619-623.
- [3]Liu J,Li XF,Xu KL,et al.Bilateral total knee arthroplasty for charcot knees associated with tabes dorsalis[J].Pain Physician,2014,17(6):796-799.
- [4]Marya SK,Thukral R.Outcome of unicompartmental knee arthroplasty in octogenarians with tricompartmental osteoarthritis:a longer followup of previously published report[J].Indian J Orthop,2013,47(5):459-468.
- [5]Mizner RL,Petterson SC,Stevens JE,et al.Early quadriceps strength loss after total knee arthroplasty.The contributions of muscle atrophy and failure of voluntary muscle activation.[J].J Bone Joint Surg Am,2005,87(5):1047-1053.
- [6]Bjerke J,?hberg F.Compensatory strategies for muscle weakness during stair ascent in subjects with total knee arthroplasty[J].J Arthroplasty,2014,29(7):1499-1502.
- [7]Noble PC,Conditt MA,Cook KF,et al.The John Insall Award:Patient expectations affect satisfaction with total knee arthroplasty[J].Clin Orthop,2006,452(1):35-43.
- [8]Mistry JB,Elmallah RD,Bhave A,et al.Rehabilitative guidelines after total knee arthroplasty:a review[J].J Knee Surg,2016,29(3):201.
- [9]Courts RD,Kaita J,Barr R.The role of eontinuous passive motion in the post-operative rehabilitation of the total knee patient[J].Orthop Trans,1982,6:277-278.
- [10]Brosseau L,Milne S,Wells G,et al.Efficacy of continuous passive motion following total knee arthroplasty:a meta-analysis[J].J Rheum,2004,31:2251-2264.
- [11]Salter RB.Continuous passive motion:from origination to research to clinical application[J].J Rheum,2004,31(11):2104-2105.
- [12]Mcinnes J,Larson MG,Daltroy LH,et al.A controlled evaluation of continuous passive motion in patients undergoing total knee arthroplasty[J].JAMA,1992,268(11):1423-1428.
- [13]Pope RO,Corcoran S,Mccaul K,et al.Continuous passive motion after primary total knee arthroplasty.Does it offer any benefits[J].J Bone Joint Surg Br,1997,79(6):914-917.
- [14]Insall JN,Ranawat CS,Aglietti P,et al.A comparison of four models of total knee-replacement prostheses[J].J Bone Joint Surg Am,1976,58(6):754-765.
- [15]Snaith RP,Zigmond AS.The hospital anxiety and depression scale[J].Health Quality Life Outcomes,2003,1(1):1-4.
- [16]梁娟,白跃宏,周俊.全膝关节置换后三维步态分析:病例-对照的随访观察[J].中国组织工程研究与临床康复,2008,12(44):8627-8630.
- [17]谢青,鲍勇,汤亦婷.人工膝关节置换者康复治疗的特征[J].中国组织工程研究与临床康复,2009,13(39):7759-7762.
- [18]Salter RB,Simmonds DF,Malcolm BW,et al.The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage.An experimental investigation in the rabbit[J].J Bone Joint Surg Am,1980,62(8):1232-1251.
- [19]范振华,周士坊.实用康复学[M].南京:东南大学出版社,1998:514.
- [20]Lindenhovius AL,van de Luijtgaarden K,Ring D,et al.Open elbow contracture release:postoperative management with and without continuous passive motion[J].J Hand Surg Am,2009,34(5):858-865.
- [21]Lenssen TA,van Steyn MJ,Crijns YH,et al.Effectiveness of prolonged use of continuous passive motion(CPM),as an adjunct tophysiotherapy,after total knee arthroplasty[J].BMC Musculoskelet Disord,2008,9:60.
- [22]Leach W,Reid J,Murphy F.Continuous passive motion following total knee replacement:a prospective randomized trial with followup to 1 year[J].Knee Surg Sports Traumatol Arthrosc,2006,14(10):922-926.
- [23]Maniar RN,Baviskar JV,Singhi T,et al.To use or not to use continuous passive motion post-total knee arthroplasty presenting functional assessment results in early recovery[J].J Arthroplasty,2012,27(2):193-200.
- [24]Insall JN,Dorr LD,Scott WN,et al.Rationale of the knee society clinical rating system[J].Clin Orthop,1989,248:13-14.
- [25]Ewald FC.The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system[J].Clin Orthop,1989,248:9-12.
- [26]K?nig A,Scheidler M,Rader C,et al.The need for a dual rating system in total knee arthroplasty[J].Clin Orthop,1997,345:161-167.
- [27]何涛,曹力,阿德力,等.全膝关节置换术前心理状态与术后早期膝关节功能的相关性研究[J].中华骨科杂志,2012,32(2):145-150.
- [28]吴慧芬,叶淑梅.围手术期患者的心理护理[J].实用临床医学,2002,3(1):139.
- [29]李心天.医学心理学[M].北京:人民卫生出版社,1991:56.
- [30]Kehlet H,Wilmore DW.Multimodal strategies to improve surgical outcome[J].Am J Surg,2002,183(6):630-641.