全膝关节置换术的康复锻炼

采用人工膝关节置换(TKR)对疾病或肿瘤造成的关节破坏进行修复，解决疼痛，畸形和功能障碍，重建一个接近正常功能的关节，是近年矫形外科中发展最快的领域之一。随着全膝关节置换术的广泛应用，术后康复日益受到重视，良好的康复活动，可以最大限度地改善假体关节功能。我院自1999年3月至2003年3月共行全膝关节置换9例，均施行了科学规范的康复锻炼，效果满意。     

全膝关节置换术病人的康复护理

对40例全膝关节置换术病人按照预定的康复计划进行术前教育、早期功能锻炼,术后6 h即开始进行膝关节锻炼,术后3 d鼓励病人下地活动。结果术后2周病人的关节平均活动度达到90°,HSS评分为82分。提示术前、术后护理及早期功能锻炼安全可行,可促进关节功能早期恢复,并可有效预防并发症。     

疼痛护理在人工全膝关节置换术后康复锻炼中的应用体会

目的探讨疼痛护理在人工全膝关节置换术后康复锻炼中的应用体会。方法对67例人工全膝关节置换术后的进行疼痛、康复训练等护理措施。结果术后随访6~18个月,膝关节屈膝活动活动范围较术前明显提升,采用HSS膝关节评分标准,优良率95.52%(64/67)。结论有效疼痛护理可以提高人工全膝关节置换术后康复锻炼的有效率和人工全膝关节的成功率。     

人工全膝关节置换术的康复锻炼

我科自1997年10月-2002年11月行人工膝关节置换11例，在实践中我们体会到正确的患肢功能锻炼是手术取得满意效果的重要条件之一。     

全膝关节置换术后的康复护理

本院开展全膝关节置换术已多年 ,从 1998～ 2 0 0 0年 12月对 36例手术患者进行针对性的康复护理 ,取得了满意的效果 ,现报告如下 :1　临床资料本组 36例 ,男 4例 ,女 32例 ,年龄为 42～ 72岁 ,平均 6 0岁。手术采用膝正中切口 ,即髌上缘以上 7.5ｃｍ处至胫骨结节内侧作膝关节前正中皮肤切开。主要病因 :类风湿性关节炎 2 9例 ,骨性关节炎 5例 ,创伤性关节炎 2例。出院后随访 1年 ,效果满意。假体位置及膝关节功能良好。2　术后康复护理积极防治术后并发症 ,人工关节置换术是人体较大的重建手术 ,术后易发生多种并发症。2 .1　出血　人工全…     

全膝关节置换术后患者居家康复锻炼方案的构建

目的 构建全膝关节置换术后患者居家康复锻炼方案,促进患者术后居家管理。方法 以知识行动框架指导方案构建,系统检索全膝关节置换术后居家康复锻炼的相关文献并评价质量,提取及汇总最佳证据形成锻炼意见;采用德尔菲法进行2轮咨询,确定居家康复锻炼内容;通过患者、实践者、管理者访谈,分析实施证据的促进因素和阻碍因素;采用专家小组会议制定居家康复锻炼内容实施的行动策略。结果 共纳入23篇文献,筛选24条锻炼意见并细化为术后2~26周的居家康复锻炼内容;确定3个促进因素与4个阻碍因素;最终形成全膝关节置换术后患者居家康复锻炼方案,并制定康复锻炼评估与实践流程图。结论 全膝关节置换术后患者居家康复锻炼方案的制定遵循实施科学的知识行动框架,纳入最佳证据,结合专业人员判断、患者意愿及可用资源,可为患者进行居家康复锻炼提供规范系统的干预指引。     

人工全膝关节置换术后早期康复护理体会

目的总结人工全膝关节置换术后早期康复护理体会。方法随机将60例人工全膝关节置换术后的患者分为2组,每组30例。对照组行常规护理,康复组在常规护理基础上采取早期康复护理。结果康复组术后下床活动时间及术后住院时间、第3天和1周的VAS评分,以及住院期间DVT发生率均优于对照组,差异均有统计学意义(P<0.05)。术后随访8~12个月。康复组术后1个月及6个月时的HSS评分和Barthel指数均优于对照组,差异均有统计学意义(P<0.05)。结论对人工全膝关节置换手术后的患者开展早期康复护理,能有效缓解疼痛程度、降低术后并发症风险,促进膝关节功能及生活能力恢复。     

全膝关节置换术的康复治疗

全膝关节置换术成功与否的因素之一为术后康复治疗。本文综述了一般全膝关节置换术后康复治疗方案。     

全膝关节置换术后持续被动训练与主动功能锻炼对患者快速康复效果的影响

目的 评估全膝关节置换术后持续被动训练与主动功能锻炼对患者加速康复效果的影响。方法 回顾性分析自2019-01—2021-12完成的80例全膝关节置换术,根据术后患者康复训练完成情况分组。A组40例依从性较差,无法规范进行主动功能锻炼,仅在持续被动训练机上进行功能训练。B组40例规范完成持续被动训练与主动功能锻炼。比较两组术后住院时间、肌间静脉血栓发生率、术后第1周疼痛VAS评分,以及术后膝关节主动活动度、膝关节功能HSS评分、患肢膝关节周径。结果 80例术后切口一期愈合,未出现切口裂开或切口感染。B组住院时间较A组缩短,术后第1周疼痛VAS评分、住院期间肌间静脉血栓发生率低于A组,术后第3天、术后1周、术后4周膝关节主动活动度、膝关节功能HSS评分明显高于A组,术后第3天、术后1周、术后4周患肢膝关节周径小于A组,差异有统计学意义（P<0.05）。结论 全膝关节置换术后患者在临床医师和康复医师指导下进行膝关节主动功能训练与持续被动训练更有利于快速康复,改善膝关节功能,减少膝关节功能障碍发生。     

肥胖患者膝关节表面置换术后的早期康复

目的探讨肥胖患者初次膝关节置换术后早期康复的方法。方法自2009年1月至2012年6月共完成肥胖患者初次膝关节置换42例42膝,男8例,女34例;年龄60～78岁,平均65岁,身体质量指数（BMI）33—52,平均46。术后早期进行持续被动关节运动增加关节活动度（ROM）和进行股四头肌及胭绳肌肌力的强化训练,延长住院时间至术后14d。分别以术前2d、术后2d、1、2、4、8、12、24周作为观察点,使用VAS疼痛评分、WOMAC评分和ROM对膝关节功能及疼痛程度进行评价。结果术后VAS疼痛评分、WOMAC评分低于术前,术后ROM高于术前,差异均有统计学意义。所有指标在术后4周以后均有逐步改善,但差异没有统计学意义。结论肥胖患者膝关节置换术后早期行功能锻炼及适当延长住院时间可以提高膝关节功能。     

Knee strength after total knee arthroplasty

Fifty-two knees in normal healthy subjects and 32 knees more than 2 years after total knee arthroplasty (TKA) were evaluated. Average isometric extension peak torque values in TKA patients were reduced by up to 30.7% (P=.01). Isometric flexion peak torque values in patients with TKA were, on average, 32.2% lower than those from control subjects throughout the motion arc (P=.004). Knee Society Functional Scores were positively correlated to the average isometric extension peak torque (r=0.57; P=.004) and negatively correlated to the average isometric hamstring to quadriceps (H/Q) ratio (r=-0.78, P<.0001). Relatively greater quadriceps strength was associated with a better functional score. Older TKA patients (>/=70 years) generated lower isometric extension peak torque values in terminal extension than younger TKA patients (>24.2%; P=.05). Higher body mass index (BMI) was associated with relative quadriceps weakness (r=0.44; P=.007). These results suggest that more thorough rehabilitation after TKA would improve functional outcomes.     

全膝关节置换术后早期功能康复

目的　探讨全膝关节置换术后进行早期功能康复的方法和时机。方法　２３ 例（３４ 膝） 骨水泥全膝关节置换术后患者按照预定的康复计划进行早期功能锻炼。术后６ ｈ 内即开始进行膝关节ＣＰＭ 锻炼,２４ ｈ 下地站立。术后引流血予以回输。结果　术后２ 周平均关节活动度达９０°,ＨＳＳ评分平均７１ 分。３ 例出现切口局部皮缘灶性坏死延期愈合,无其它并发症。结论　术后早期功能锻炼安全可行,可使关节功能早期恢复,并可有效预防并发症。     

Comparison of muscle strength of posterior cruciate-retained versus cruciate-sacrificed total knee arthroplasty

One of the most controversial issues in total knee arthroplasty is whether to retain or sacrifice the posterior cruciate ligament (PCL). Investigators have used various methods to evaluate the influence of the PCL after total knee arthroplasty, but muscle strength evaluation has not been reported. The purpose of this study is to compare the long-term effects of PCL retention or sacrifice on muscle strength. Isokinetic testings and isometric testings were studied in patients with three different types of prosthesis design: total condylar, low contact stress rotating platform (both sacrifice PCL), and low contact stress meniscal bearing (retains PCL). The results showed that in all testing conditions, the hamstring to quadriceps ratios did not significantly differ among the three prosthetic designs (P > .05) even after long-term (6–13 years) functional adaptation.     

Changes in muscle torque in patients after total knee arthroplasty

AIM: The purpose of this study was to compare muscle torque during isokinetic knee movements of patients after total knee arthroplasty (TKA) with a similar healthy group. METHOD: 43 patients were examined 3 years after primary total knee arthroplasty with an isokinetic dynamometer (Cybex 340). Torque measurements were evaluated for extension and flexion with 4 different velocities. The results were compared with a group of 43 people without knee disease. Bouth groups consist of 29 women and 14 men. The mean age was also comparable (66.4 vs. 65.8 years). RESULTS: A mean peak torque of 65.9 Nm was measured during extension with low velocity (60 degrees /s) in the group of patients with TKA -- 84.3 % of the control group (p = 0.079). At the highest velocity the patients produced 30.2 Nm. This was 72.8 % of the control group (difference statistically significant, p = 0.006). No differences were found in the Extension/Flexion ratio between the two groups. CONCLUSION: The deficites of knee strength in patients after TKA are more distinct in high velocities of motion.     

性别对骨关节炎患者全膝关节置换术后康复效果的影响

目的 探讨性别因素对接受人工全膝关节表面置换术的膝骨关节炎患者术后功能的影响. 方法 前瞻性研究了 2003年 3月～ 2005年 8月期间行单侧人工全膝关节表面置换术(均使用不保留后交叉韧带后稳定型固定平台假体)的 40例 (40髋 )膝关节骨关节炎患者,男女各 20例( 20膝),对其相关的临床因素用 t检验和χ 2检验进行分析. 结果平均年龄:男 72.6岁、女 70.8岁;病程:男 10.4年、女 9.7年;体重指数:男 26、女 26;术后平均住院时间:男 17 d、女 18 d;止血带使用时间:男 104 min、女 94 min;引流量:男 806 mL、女 742 mL;术前、术后 1周、 2周和 1年的膝关节伸屈度数男分别为 7.0°～ 114.0°、 3.0°～ 91.0°、 0.4°～ 103.0°和 0～ 125.0°,女分别为 8.0°～ 111.0°、 2.0°～ 86.0°、 1.0°～ 98.0°和 0～ 122.0°;术前、术后 1周、 2周和 1年的膝关节活动度:男分别为 108°、 89°、 109°和 123°,女分别为 104°、 87°、 101°和 126°;术前和术后 1年的 HSS评分:男分别为 57、 89分,女分别为 53、 87分.两性别组各时间点的伸屈度数、活动范围及术前和术后 1年的 HSS评分差异无统计学意义 (P >0.05);而同一患者术前和术后 1年的伸屈度数及 HSS评分则差异有统计学意义 (P >0.05). 结论 性别对行全膝关节置换的骨关节炎患者术后功能无明显影响,全膝关节置换能有效缓解骨关节炎相关的疼痛并改善膝关节的功能.     

双膝关节同次置换术后的早期康复锻炼

目的：探讨双膝关节置换术前和术后功能锻炼的原则和方法。方法：自2005年1月至2008年6月共完成双膝关节置换72例144膝,男33例,女39例;年龄46～78岁,平均69岁。其中骨性关节炎54例,类风湿性关节炎17例,创伤性关节炎1例。屈曲挛缩大于30°者7例9膝,固定内翻畸形大于30°者10例15膝,固定外翻畸形大于15°者6例8膝。按照术前、术后早期和术后远期的分期为患者制定合理的锻炼计划,在多模式镇痛的前提下术后及早开始功能锻炼,通过增加关节活动度（ROM）和股四头肌及腘绳肌肌力的强化训练提高手术效果。使用WOMAC评分、ROM和6min行走距离以及VAS疼痛评分分别对术前、术后膝关节功能及疼痛程度进行评价,术后下肢血管超声判断血栓的形成,根据临床表现和D-二聚体水平诊断肺栓塞。结果：分别以术前2d、术后2d及术后1、2、8、24周作为观察点。失访3例6膝。术后WOMAC评分、VAS疼痛评分低于术前,术后ROM和6min持续行走距离高于术前。128膝可在术后2周内完全伸直,屈曲大于90°,135膝术后8周屈曲可达110°。发生单侧下肢静脉血栓2例2膝,双侧下肢血栓1例2膝,未见肺栓塞发生。结论：双侧膝关节同时置换应制定术前、术后早期和术后远期功能锻炼计划,并在多模式镇痛的前提下术后早期行功能锻炼,以提高膝关节功能并降低疼痛和肿胀。     

Baropodometry on patients after total knee arthroplasty

Purpose

It is well known that total knee replacement surgery decreases pain and improves function, but the effect on postural assessment needs to be studied better with the use of new technological devices. Total knee arthroplasty (TKA) improves motor coordination and stability of the knee. On the other hand, changing joint functionality can modify the balance. The aim of this trial is to record and analyze the static and dynamic baropodometric data of patients in the first few months following joint replacement. For the physiatrist, this tool can be useful to check if the rehabilitation treatment protocols and times are correct.

Methods

We designed a prospective observation longitudinal study to assess postural stability following TKA. Between December 2014 and May 2015, sixty consecutive patients were recruited through local orthopedic physician offices and hospitals. The patients scheduled to undergo TKA were recruited and were monitored before surgery (T0) and at 1 (T1), 3 (T2) and 6 months (T3) after knee surgery. The correction of varus/valgus deviation at X-ray and the Knee Society Score were performed to verify the functional recovery. We used static and dynamic baropodometric analysis to evaluate postural assessment.

Results

After surgery, there was a significant improvement in physiological alignment of knee axes (p < 0.0001) and of Knee and Function Scores (excellent, mean values 80.5 and 80.7, respectively, p < 0.0001). The static analysis showed that the center of gravity and the pressure on the foot of the operated limb were corrected toward the physiological center (p < 0.0001) and the body weight displaced to the forefeet and to the hindfeet reduced bilaterally (p < 0.0001). The type of footprint did not change. The dynamic analysis confirmed the significant normalization of the pressure on the foot of the operated limb at all follow-ups (p < 0.0001). The percentage of load was reduced on the operated limb (p = 0.0096) and speed of step, cadence and semi-step length increased (p < 0.0001).

Conclusion

These data show the progressive recovery of stability after TKA from the immediate postoperative to the subsequent months. The clinical and functional improvement correlated with a load redistribution between the two limbs. The baropodometry could be an excellent noninvasive method for monitoring effects of rehabilitation treatment.