静态进展性牵伸结合关节松动术在全膝关节置换术患者中的应用效果

目的探讨静态进展性牵伸(SPS)结合关节松动术对全膝关节置换术(TKA)患者视觉模拟评分法(VAS)评分、膝关节活动度、美国特种外科医院膝关节评分系统(HSS)评分的影响。方法采用随机抽样法选取75例TKA患者作为研究对象,以摸球法分为2组,对照组37例采用关节松动术,研究组38例采用SPS结合关节松动术,比较2组患者的疗效。结果治疗后4、8周时,研究组VAS评分低于对照组,膝关节活动度、HSS评分高于对照组,差异均有统计学意义(P 0. 05);研究组总有效率为97. 37%,高于对照组的78. 38%,差异有统计学意义(P 0. 05)。结论 TKA患者采用SPS结合关节松动术治疗,可减轻疼痛,改善膝关节活动度及关节功能,提升疗效。     

术后早期应用静态进展性牵伸治疗对股骨中下段骨折患者膝关节功能的影响

目的:观察术后早期应用静态进展性牵伸治疗对股骨中下段骨折患者膝关节功能的影响。方法:选取在我院接受内固定手术的股骨中下段骨折患者48例,随机分为观察组和对照组各24例。术后3天,2组患者均采用物理因子治疗、CPM、运动功能训练等常规康复治疗,观察组在此基础上应用IK膝关节牵伸系统进行静态进展性牵伸治疗。分别于治疗前、术后4周和术后12周对2组患者进行疼痛视觉模拟评分(VAS)和膝关节主动关节活动度测量(AROM);于术后24周对2组患者用特种外科医院膝关节评分(HSS)评估膝关节功能、X线检查评估骨折愈合情况。结果:术后4及12周后,2组患者VAS评分均较治疗前呈明显下降趋势(均P0.05,0.01),且低于同时间点对照组(均P0.05)。术后4及12周后,2组患者AROM均较治疗前呈明显增加趋势(均P0.05);术后4周2组组间比较差异无统计学意义,术后12周观察组患者AROM明显高于同时间点对照组(P0.05)。术后24周,观察组患者HSS评分明显高于对照组(P0.05)。术后24周,2组患者X线检查均有骨痂通过骨折线,患肢无纵向扣击痛,不扶拐能行走3min,对比之前X线片骨折无变形,内固定无松动开裂,无骨不连发生。结论:对股骨中下段骨折患者,术后早期应用静态进展性牵伸治疗可有效缓解疼痛,扩大膝关节主动活动范围,提高膝关节功能,且不增加骨不连风险。     

关节松动术联合物理因子治疗全膝关节置换术后膝关节活动受限的疗效观察

目的观察关节松动术联合物理因子对全膝关节置换术（TKA）后膝关节活动受限的影响。 方法选取因膝关节骨性关节炎行TKA术后膝关节活动受限患者51例,采用随机数字表法分为治疗组（26例）和对照组（25例）。2组患者均采用相同的物理因子（红外线和调制中频）治疗方案,治疗组在上述物理因子治疗的基础上增加关节松动术治疗。于治疗前和治疗30d后（治疗后）,分别采用视觉模拟评分法（VAS）、关节活动度和临床治疗疗效标准对2组患者进行疗效评价。 结果治疗后,2组患者的VAS评分和关节活动度与组内治疗前比较,差异均有统计学意义（P<0.05）,且治疗组患者治疗后的关节活动度为（110.15±10.13）°,与对照组治疗后的（85.49±15.84）°比较,差异有统计学意义（P<0.05）。治疗后,治疗组患者的显效率显著优于对照组,差异有统计学意义（P<0.05）。 结论关节松动术联合物理因子治疗TKA后术侧膝关节活动受限,可有效地缓解患者膝关节的疼痛,改善膝关节关节度,提高疗效。     

早期康复训练对全膝关节置换术后关节功能恢复的影响

探讨早期进行康复训练对人工全膝关节置换(TKA)术后关节功能恢复的影响.对32例人工TKA患者术前、术后进行系统康复训练.术后半年复查,优18例,良10例,中4例;30例能独立行走,2例需扶单拐行走,生活均能完全自理.早期进行康复训练有利于人工TKA术后膝关节功能恢复.     

早期康复训练对全膝关节置换术后关节功能恢复的影响

[目的]探讨早期进行康复训练对人工全膝关节置换(TKA)术后关节功能恢复的作用。[方法]对21例进行人工TKA术前、术后系统康复训练,半年后采用美国特种外科医院(HSS)膝关节百分评分系统进行评分。[结果]术后半年复查,优15例,良5例,中1例;20例能独立行走,1例需扶单拐行走,均能完全自理。[结论]早期进行康复训练有利于人工TKA术后膝关节功能恢复。     

早期康复训练对全膝关节置换术后关节功能恢复的影响

[目的]探讨早期进行康复训练对人工全膝关节置换(TKA)术后关节功能恢复的作用。[方法]对21例进行人工TKA术前、术后系统康复训练，半年后采用美国特种外科医院(HSS)膝关节百分评分系统进行评分。[结果]术后半年复查，优15例，良5例．中1例；20例能独立行走，1例需扶单拐行走，均能完全自理。[结论]早期进行康复训练有利于人工TKA术后膝关节功能恢复。     

关节线高度改变对行人工全膝关节置换术患者早期疗效的影响

目的探讨行人工全膝关节置换术(total knee arthroplasty,TKA)重度膝关节骨关节炎患者关节线高度改变对早期疗效的影响。方法重度膝关节骨关节炎患者62例,均初次行TKA,依据手术前后关节线高度改变分为-4^-2 mm组8例,>-2~2 mm组30例,>2~4 mm组15例,>4 mm组9例。比较4组术前及术后1 a膝关节活动度、美国特种外科医院(Hospital for Special Surgery,HSS)评分、西安大略和麦马斯特大学骨关节炎指数可视化量表(Western Ontario and McMaster Universities Osteoarthritis Index,WOMAC)评分。结果-4^-2 mm组、>-2~2 mm组、>2~4 mm组术后膝关节活动度增加值[(53.14±17.92)°、(51.32±14.40)°、(51.82±14.21)°]、HSS评分增加值[(26.50±12.63)、(14.33±2.61)、(17.32±4.47)分]较>4 mm组[(40.58±18.69)°、(13.32±4.44)分]大(P<0.05),-4^-2 mm组、>-2~2 mm组、>2~4 mm组比较差异无统计学意义(P>0.05);>2~4 mm组术后WOMAC评分增加值[(-35.47±6.89)分]较>4 mm组[(-40.44±9.67)分]大(P<0.05),-4^-2 mm组[(-35.50±10.42)分]、>-2~2 mm组[(-39.30±8.65)分]与>4 mm组比较差异无统计学意义(P>0.05)。结论初次TKA术后关节线高度增加>4 mm会影响膝关节活动度及膝关节功能。     

关节松动术联合物理因子治疗人工全膝关节置换术后关节活动受限的临床疗效观察

目的观察关节松动术联合物理因子治疗人工全膝关节置换术(TKA)后侧膝关节关节活动受限的临床疗效。 方法选取TKA术后骨性关节炎（OA）患者51例,按随机数字表法将其分为治疗组26例和对照组25例。2组患者均采用传统的物理因子治疗方案,治疗组在此基础上增加关节松动术治疗。治疗前和治疗30d后（治疗后）,分别采用目测类比法（VAS）、量角器和临床治疗疗效标准对2组患者疼痛、关节活动度(ROM)及临床疗效进行评价。 结果治疗后,2组患者膝部的VAS评分和ROM与组内治疗前比较,差异均有统计学意义（P<0.05）,且治疗组治疗后的ROM为（110.15±10.13）°,显著优于对照组治疗后的（85.49±15.84）°,组间差异有统计学意义（P<0.05）。治疗后,治疗组患者的优良率和总有效率均优于对照组,组间比较,组间差异均有统计学意义（P<0.05）。 结论关节松动术联合物理因子治疗TKA后关节活动受限,不仅能有效地缓解患者膝关节肿胀和疼痛,还可显著改善膝关节ROM,提高临床疗效。     

全膝关节置换术后肌力训练对膝关节功能的影响

目的探讨肌力训练对全膝关节置换术后患膝关节功能恢复的影响。方法选取96例全膝关节置换患者，将其随机分为观察组及对照组。对照组患者术后给予常规康复训练；观察组患者在此治疗基础上，重点进行股四头肌及胭绳肌肌力训练。治疗2周后分别对2组患者的膝关节活动度、疼痛、股四头肌和胭绳肌肌力进行评定，并采用美国膝关节外科学会膝关节评分法（KSS）、美国特种外科医院（HSS）膝关节百分评分系统对患膝功能进行评定。结果2组患者经治疗后，其膝关节活动度及疼痛方面组间差异均无统计学意义（P〉0．05），但股四头肌、胭绳肌肌力及KSS、HSS总分组间差异均有统计学意义（P〈0．01）。结论肌力训练对全膝关节置换患者膝关节功能的恢复具有显著促进作用，可有效增强患膝关节的稳定性，改善患肢功能，提高生活质量。     

Biomechanical effects of joint line elevation in total knee arthroplasty

Background

Inadequate restoration of the knee joint line after total knee arthroplasty may lead to a poor clinical outcome. The purpose of this study was to quantitatively assess the effects of joint line elevation following total knee arthroplasty with increased joint volume on patellofemoral contact kinematics.

Methods

Six cadaveric specimens were tested. Patellofemoral contact area, contact pressure, and kinematics were measured following total knee arthroplasty with an anatomic joint line and after 4 and 8 mm of joint line elevation, at knee flexion angles of 0°, 30°, 60°, 90° and 120°. Repeated measures analysis of variance with a Tukey post hoc test with a significance level of 0.05 was used for statistical analyses.

Findings

There was a decrease in contact area with joint line elevation at flexion angles of 60°, 90° and 120° (P = 0.009–0.04). There was a significant increase in contact pressure only at 30° of knee flexion with 8 mm of joint line elevation (P = 0.004). Three of the six specimens showed inferior edge loading of the patella component following 8 mm of joint line elevation at 120° of knee flexion. The sagittal plane patellofemoral angle increased significantly with joint line elevation except for 0° knee flexion (P = 0.0002–0.02).

Interpretation

Knee joint line elevation with increased knee volume significantly affects patellofemoral contact area and kinematics and produced inferior edge loading/impingement between the patella and tibial components, this may result in loss of knee range of motion, postoperative pain, and premature component wear.     

Factors affecting early knee-flexion range of motion after total knee arthroplasty

[Purpose] To investigate the factors affecting the knee-flexion range of motion in the early period after total knee arthroplasty. [Participants and Methods] Ninety-nine patients who had undergone total knee arthroplasty at our hospital between 2016 and 2019 were allocated into two groups based on the presence of a 110° knee-flexion range of motion at 14 days post-surgery. From medical records, we extracted data for the participants’ basic attributes and preoperative/postoperative physical function (knee-flexion range of motion, Timed Up & Go Test results, resting/walking pain according to a numerical rating scale, and knee-extension muscle strength). Postoperative physical function was measured 14 days post-surgery. [Results] Preoperative knee-flexion range of motion, preoperative femorotibial angle, postoperative knee-extensor strength, and postoperative Timed Up & Go Test value differed significantly as factors related to achieving a 110° knee-flexion range of motion. Through further statistical analyses, we selected the preoperative knee-flexion range of motion, preoperative femorotibial angle, preoperative Timed Up & Go Test result, and postoperative knee-extension strength as factors affecting the knee-flexion range of motion at 14 days post-surgery. [Conclusion] Preoperative knee-flexion range of motion, preoperative femorotibial angle, preoperative Timed Up & Go Test result, and postoperative knee-extension strength influence knee-flexion range of motion at 14 days after total knee arthroplasty, and our findings indicate the effectiveness of active physiotherapy interventions.     

人工膝关节置换术后连续被动活动对关节功能的影响

目的观察连续被动活动(CPM)对人工膝关节置换术后膝关节功能的恢复情况,进行临床对照研究评估连续被动活动在全膝置换术后康复中的作用。方法将本院行首次全膝置换的44例患者以单纯随机抽签方法分成两组,23例术后除行物理康复治疗外辅助应用CPM康复治疗,21例患者仅行物理康复治疗。对所有患者进行术后随访,记录术后第7,10,14天,6周,6个月及1年时的关节活动范围(ROM)。结果与未应用CPM组相比,应用CPM组患者平均膝关节活动度在术后7,10,14d,6周,3,6个月及1年时分别多19°,15°,10°,8°,8°,2°和5°(t=4.763,3.621,3.529,2.614,2.507,2.178,2.117,P<0.05)。结论CPM有助于全膝置换患者术后较早恢复膝关节活动度。     

Dynamic joint stiffness and co-contraction in subjects after total knee arthroplasty

Background

Although total knee arthroplasty reduces pain and improves function, patients continue to walk with asymmetrical movement patterns, that may affect muscle activation and joint loading patterns. The purpose of this study was to evaluate the specific biomechanical abnormalities that persist after total knee arthroplasty and examine the neuromuscular mechanisms that may contribute to these asymmetries.

Methods

Dynamic joint stiffness at the hip, knee and ankle, as well as co-contraction at the knee and ankle, were compared between the operated and non-operated limbs of 32 subjects who underwent total knee arthroplasty and 21 subjects without lower extremity impairment.

Findings

Subjects after total knee arthroplasty demonstrated higher dynamic joint stiffness in the operated knee compared to the non-operated knee (0.056 (0.023) Nm/kg/m/deg vs. 0.043 (0.016) Nm/kg/m/deg, P = 0.003) and the knees from a control group without lower extremity pathology (controls: 0.042 (0.015) Nm/kg/m/deg, P = 0.017). No differences were found between limbs or groups for dynamic joint stiffness at the hip or ankle. There was no relationship between dynamic joint stiffness at the knee and ankle and the amount of co-contraction between antagonistic muscles at those joints.

Interpretation

Patients after total knee arthroplasty walk with less knee joint excursion and greater knee stiffness, although no differences were found between groups for stiffness at the hip or ankle. Mechanisms other than co-contraction are likely the underlying cause of the altered knee mechanics. These findings are clinically relevant because the goal should be to create interventions to reduce these abnormalities and increase function.     

全膝关节置换术后关节假体周围感染危险因素的Meta分析

目的分析全膝关节置换术（TKA）后发生关节假体周围感染（PJI）的相关危险因素。 方法计算机检索由建库至2019年11月的中文数据库中国知网、万方数据库、维普中文科技期刊数据库以及中国生物医学文献服务系统,按拟定的文献纳入与排除标准获取中国人群TKA后发生PJI的相关危险因素的文献,提取有效数据进行Meta分析,绘制森林图,分别采用固定效应模型和随机效应模型计算各相关危险因素（类风湿性关节炎、激素治疗史、糖尿病、手术时间、术中出血量、吸烟、术后放置引流）的合并优势比（OR）值和95%CI,分析各危险因素与TKA后发生PJI的关联强度。 结果共纳入12篇文献,各危险因素合并OR值（95%CI）由高到低依次为类风湿性关节炎（OR=4.84,95%CI：1.87~12.49）、激素治疗史（OR=4.75,95%CI：2.84~7.93）、糖尿病（OR=2.57,95%CI：2.00~3.30）、手术时间（OR=2.19,95%CI：1.57~3.04）、术后放置引流（OR=2.09,95%CI：1.44~3.04）、吸烟（OR=1.76,95%CI：1.26~2.44）、术中出血量（OR=1.34,95%CI：1.06~1.70）。 结论类风湿性关节炎、激素治疗史、糖尿病、手术时间、术后放置引流、吸烟、术中出血量均为TKA后PJI的危险因素,各危险因素与TKA后发生PJI的关系均呈正相关。     

Efficacy of instrument-assisted soft tissue mobilization in comparison to gastrocnemius-soleus stretching for dorsiflexion range of motion: A randomized controlled trial

ObjectivesTo determine the efficacy of IASTM of the gastrocnemius-soleus complex in comparison to a traditional stretching intervention on dorsiflexion ROM.MethodsSixty healthy participants were randomly allocated to one of 3 groups: IASTM (n = 20), stretching (n = 20), or control group (n = 20). The dependent variables for this study was dorsiflexion range of motion (ROM) via three measurement methods which included Modified root position 1- knee extended (MRP1), Modified root position 2- knee flexed (MRP2), and weight bearing lunge test (WBLT). A multivariate analysis of variance (MANOVA) was utilized to analyze the ROM differences between the groups (IASTM, stretching, and control groups), with a post-hoc Tukey and pairwise least significant difference tests to assess individual pairwise differences between the groups.ResultsThe MANOVA found significant ROM differences between the three intervention groups (F_6,110 = 2.40, p = .032). Statistically significant differences were identified between both the IASTM and control as well as the stretching and control group through the WBLT and MRP2 assessments, but not in the MRP1 assessment. Further, there was no statistically significant difference between the IASTM and stretching groups using any of the three methods.ConclusionA single session of IASTM or stretching increased ankle dorsiflexion ROM in WBLT and MRP2. No significant difference was noted in the MRP1. Both IASTM and stretching appear to have a greater effect on soleus muscle flexibility as evidenced by ROM gains measured with the knee in a flexed position. No clinically significant difference was identified between the intervention groups in weight-bearing conditions; thus empowering patients with the use of self-stretching would seemingly be reasonable and efficient. Combined effects of stretching and IASTM warrant further investigation for increasing dorsiflexion range of motion as a summative effect is unknown.     

单髁置换术与微创全膝关节置换术治疗老年膝关节骨性关节炎的临床效果

目的比较单踝置换术(UKA)及微创全膝关节置换术(MIS-TKA)治疗老年膝关节骨性关节炎的临床效果。方法选取2015年1月至2018年1月我院收治的84例膝关节骨性关节炎老年患者为研究对象,根据治疗方式的不同将其分为单踝组(42例,UKA)与全膝组(42例,MIS-TKA)。比较两组临床疗效。结果单踝组手术时间、住院时间及直腿抬高时间短于全膝组,术中出血量少于全膝组(P<0.05)。术后1个月,单踝组KSS各项评分均优于全膝组(P<0.05)。术后6个月,单踝组动态步态指数及ROW均高于全膝组(P<0.05),但术后12个月时无差异(P>0.05);术后6、12个月,两组HSS评分均无差异(P>0.05)。术后6个月,两组AIMS2-SF评分均升高,但组间无差异(P>0.05)。结论 UKA与MIS-TKA均是治疗老年膝关节骨性关节炎的有效术式,能有效改善膝关节功能,提高生活质量水平,但UKA的创伤及出血少,对膝关节骨性关节炎术后恢复更有优势。