CPM机在膝关节周围骨折术后康复中的应用研究

目的：探讨CPM机在膝关节周围骨折术后的康复应用，使膝关节功能最大限度改善。方法：采用不同病例对照研究，对照组沿用传统的康复方法。而实验组早期使用下肢关节康复器（CPM）进行肢体功能康复训练。结果：实验组膝关节功能明显优干对照组（P〈0．05）。结论：对膝关节周围骨折术后实施CPM机早期康复训练，膝关节功能明显改善，值得推广应用。     

全膝关节置换术后的康复训练指导体会

目的通过对人体膝关节置换术患者的术后康复指导，加快和促进膝关节功能的恢复。方法对我院近年来开展的全膝关节置换术患者重点制定康复训练计划，协助指导教会患者术后早期进行规范系统的康复训练；患者静力性收缩，股四头肌等长收缩训练，直腿抬高训练，膝关节屈曲锻炼，扶双拐下地步行以及上下楼梯等，防止术后膝关节挛缩，改善关节功能。在预防并发症的同时术后当日即开始实行康复锻炼，逐日递增直至出院并给予康复指导。结果能有效减少并发症，促进膝关节功能恢复，提高患者的生活质量，采用HSS平分标准均为优良。结论全膝关节置换术后对患者进行康复指导和训练很有必要。     

全膝关节置换术后早期康复对膝关节功能和日常生活活动能力的影响

目的:探讨全膝关节置换术(Total Knee Arthroplasty,TKA)后早期康复对患者功能改善的效果.方法:单侧全膝关节置换术患者60例,随机分为康复治疗组30例和对照组30例,康复治疗组按我科制定的康复训练程序进行早期康复治疗,对照组采用常规CPM机进行持续被动运动,在入院后和出院前分别对两组患者的患膝进行主动关节活动度(AROM),WOMAC量表以及FIM量表的评定,对结果进行比较.结果:出院时两组患者膝关节活动度、WOMAC及FIM评分均比入院时有明显改善(P<0.01),其中康复治疗组AROM显著高于对照组(P<0.01),康复治疗组WOMAC量表每项积分均低于对照组(P<0.05,P<0.01),康复治疗组的FIM评估在生活自理、转移、行进三项内容积分高于对照组(P<0.05).结论:全膝关节置换术后早期康复能明显改善患者膝关节功能水平,对生活自理、转移、行进三方面能力亦有改善和提高.     

人工全膝关节置换术后的康复锻练

目的：为减轻人工膝关节置换术后患者的疼痛,以及增加术后人工关节的活动范围,提高患者术后的生活质量,为患者提供并施行康复训练计划。方法对膝关节置换术患者术前进行心理疏导,术后给予护理及康复锻炼指导,出院进行健康宣教,并定期随访。结果优19例,良4例,可2例。手术效果满意。结论人工膝关节置换术后患者通过康复锻炼,能够得到更好的功能恢复,可以减少并发症。     

人工膝关节置换术后护理体会

目的：总结全膝关节置换术后进行早期功能锻炼的经验。方法480例人工全膝关节置换术后的患者按照预定的康复计划进行早期功能锻炼，术后6 h开始进行股四头肌群锻炼，48 h后开始进行CPM 锻炼，3 d下地站立。结果术后2周平均活动度达90％以上，切口Ⅰ期愈合，无其他并发症，手术优良率达96％。结论术后早期功能锻炼安全可行，可使关节功能早期恢复，并可预防并发症。     

髋关节置换术病人的家庭康复指导

目的探讨人工髋关节置换术后病人进行家庭康复指导方法和效果。方法对108例人工髋关节置换术后病人进行家庭康复指导的方法和效果进行分析。结果对生活方式的康复指导和支具使用认知效果最佳,96％的病人学到了康复训练的知识。结论髋关节置换术后病人进行家庭康复指导可以提高疗效,促进功能的恢复。     

CPM机在膝关节功能康复中的早期应用及护理效果观察

目的:探讨CPM机在膝关节功能康复中的应用临床效果及应该采取的护理对策。方法:回顾性调查分析我院从2008-2010年间膝关节附近骨折252例,其中126例术后行CPM辅助膝关节功能康复锻炼者为观察组,126例行传统手法辅助功能锻炼者为对照组。比较两组的膝关节功能康复情况及其相应采取的护理对策。结果:观察组优良率为100%,对照组优良率为89.6%,两组间差异非常显著(P<0.01)。结论:膝关节附近骨折患者术后早期应用CPM机辅助康复锻炼具有肯定的促进膝关节功能恢复的意义,能有效防止再粘连,尽快达到满意的活动范围。     

人工全膝关节置换术围术期的护理体会

人工全膝关节置换术主要用于骨性关节炎、类风湿性关节炎、创伤性关节炎等引起严重的膝关节疼痛、畸形、活动障碍,严重影响工作及生活质量的患者。我科于2008年1月-2011年10月,共行38例人工全膝关节置换术,经过对患者围手期的精心护理,以及术后合理的康复训练,获得较好的膝关节功能。现分析报告如下。     

老年髋部骨折患的术后护理与康复指导

目的：探讨老年髋部骨折术后的护理方法与康复指导,提高患者生活质量。方法：针对不同病案,制定完善系统的康复训练计划,使老年患者恢复生活自理,取得最大限度的功能恢复。结果：48例手术均成功,平均住院天数23 d,切口一期愈合,其中2例患者惧怕疼痛,不配合康复训练,并发关节僵硬,配合CPM机治疗后逐级恢复功能,出院。结论：对老年髋部骨折患者除进行完善的康复训练指导,早期介入功能训练,是帮助患者恢复功能的重要手段。     

髌骨骨折术后早期康复训练的体会

目的：探讨早期康复训练对髌骨骨折术后膝关节功能恢复的临床意义。方法：张力带内固定术后给予骨科治疗护理的基础上同时给予早期康复训练,于术后6个月进行疗效评估。结果：膝关节功能评定,膝关节功能恢复优良率97%。结论：早期康复训练对髌骨骨折术后膝关节功能恢复作用明显。     

综合运动训练对全膝关节置换术功能及预后的影响

目的研究综合运动训练对全膝关节置换术功能及预后的影响,为临床治疗提供一定的理论依据。方法按照入院先后顺序入选64例全膝关节置换术患者,根据随机数字方法分成两组,每组32例,其中对照组予以单纯的持续被动运动训练,而研究组在持续被动运动的基础上再综合其它的运动训练以及超短波和超声波治疗。治疗随访6周后,分析两组患者的相关临床资料。结果与对照组相比较,研究组在膝关节的功能、活动度、稳定度、疼痛、肌力及屈曲畸形等方面的HSS评分明显改善(P<0.05)。同时,通过统计发现,对照组的优良率为53.13%,而研究组的优良率为84.38%,明显高于对照组(P<0.05)。结论综合运动训练的康复治疗方式可以很好的改善全膝关节置换术患者的膝关节功能及其预后。     

兔膝关节持续被动活动器的研制与初步应用

目的:为解决实验动物兔术后膝关节早期康复中的持续被动活动(continuous passive mo-tion,CPM)问题,自行研制一种兔膝关节持续被动活动器。方法:根据仿生学原理设计,兔膝关节持续被动活动器主要由支架部分、驱动部分、传动机构和固定部分组成。在23只8月龄雄性新西兰大白兔右侧后肢膝关节切断前交叉韧带后,行自体双股半腱肌移植重建前交叉韧带手术,术后随机分为2组:CPM组与自由活动组。CPM组应用兔膝关节持续被动活动器行早期关节全范围活动康复,每天2次,每次5小时,共6周。不运动时以两片低温热塑板材和尼龙搭扣固定膝关节;自由活动组仅笼内自由活动。观察装置运行情况和兔体重、膝关节肿胀、伤口愈合、关节活动度的变化。结果:整个装置安全可靠,动力足够带动5只兔子同步运动;可以准确、方便地调节膝屈曲角度、运动速度和时间,满足实验要求。CPM组兔子能安静耐受5小时的被动训练,训练期间,未出现坠积性水肿、皮肤破损、压疮、骨折,伤口愈合良好。CPM组术后肿胀程度明显小于自由活动组,且有显著性差异(P<0.01)。2组的体重和关节活动度变化无显著性差异(P>0.01)。结论:兔膝关节持续被动活动器是一种简便可靠、效果较好的术后早期康复器械。     

Range of motion training in brace vs. plaster immobilization after anterior cruciate ligament reconstruction: a prospective randomized comparison with a 2-year follow-up

The purpose of this prospective and randomized study was to compare rehabilitation with early range of motion (ROM) training vs immobilization following anterior cruciate ligament (ACL) reconstruction. Fifty patients, undergoing an ACL reconstruction with a bone-patellar tendon-bone graft, were postoperatively allocated randomly to either a plaster cast or a brace for 5 weeks. The brace group had ROM exercises from postoperative day 7. The commencement of ROM exercises was postponed 4 weeks for the plaster group compared to the brace group, but progressed subsequently with equal speed. There was no difference between the groups in the ROM of flexion or extension 20 weeks after the ACL reconstruction and later. Twenty-four months after surgery, the muscle strength deficit in the hamstring muscles (isokinetic measurements; percent difference, injured vs uninjured) was significantly larger in the brace group (mean +/- SD: 5.9 +/- 7.8%, P < 0.01) than in the plaster group (- 0.9 +/- 11.8%, NS) (brace vs plaster group, P < 0.05). Furthermore, there was also a tendency in the brace group to a larger strength deficit in the quadriceps muscle (brace: 11.1 +/- 13.2%, P < 0.001; plaster: 3.8 +/- 12.9%, NS) (brace vs plaster group, P= 0.07). There was no difference between the groups in the total sagittal knee laxity, as measured with an arthrometer, or in the subjective knee function or activity level (Lysholm score together with the Tegner activity level) between the groups. It is concluded that the postoperative treatment with early range of motion training after ACL reconstruction gave as good ROM, knee stability, subjective knee function and activity level as the treatment with immobilization. It is hypothesized that the larger strength deficit observed after rehabilitation with early range of motion training is secondary to the more intensive training and physical therapist involvement that was demanded in order to achieve full ROM following immobilization.     

快速康复理念在骨肉瘤人工膝关节置换术围术期中应用

目的探讨快速康复理念在骨肉瘤人工膝关节置换术围术期实施方法及效果观察。方法选取中国医科大学附属第四医院骨外科自2013年10月至2017年1月收治的15例采用人工膝关节置换术治疗的骨肉瘤患者设为快速康复组,围术期采用快速康复理念管理;18例采用人工膝关节置换术治疗的骨肉瘤患者设为常规组,实施常规治疗。比较两组的术后康复情况。结果快速康复组患者术后下床活动时间明显早于常规组,并发症明显少于常规组,术后膝关节活动度的优良率明显高于常规组,随访3个月时的膝关节功能评分明显高于常规组,两组间比较,差异均有统计学意义(P<0.05)。结论对骨肉瘤人工膝关节置换术的患者围术期实施快速康复管理,能够促进术后康复。     

持续被动活动对兔重建前交叉韧带生物力学特性的影响

目的:采用半腱肌腱重建兔前交叉韧带(ACL),探讨持续被动活动(CPM)对移植物生物力学特性的影响。方法:对30只8月龄雄性新西兰大白兔右侧后肢膝关节行自体双股半腱肌腱移植重建前交叉韧带手术。术后随机分为CPM组和非CPM组两组:CPM组术后第2天开始采用自制兔膝关节CPM器进行持续被动活动,共6周;非CPM组仅笼养。分别于术后第6、12、24周取材,每组每次取5只行生物力学观察。结果:与非CPM组相比,CPM组大部分标本两束融合成一体。从术后6周到24周,所有移植物的最大载荷、最大应力、弹性模量以及这些指标和其对照侧ACL的比值逐渐增加。在术后6、12、24周时,CPM组移植物最大载荷分别为22.72N、79.56N、122.20N,最大应力分别为4.58MPa、13.62MPa、21.79MPa;非CPM组移植物最大载荷分别为16.00N、70.68N、96.20N,最大应力分别为3.07MPa、11.58MPa、17.89MPa。3个时间点两组间上述指标差异均具有统计学意义(P<0.05)。结论:半腱肌腱重建兔前交叉韧带术后早期进行持续被动活动可明显提高移植物的生物力学性能。     

Knee joint functional range of movement prior to and following total knee arthroplasty measured using flexible electrogoniometry

The functional ranges of movement of the knee were investigated in a group of patients with knee osteoarthritis (n = 42, mean age 70 years) before, 4 months and at 18-24 months after total knee arthroplasty and then compared with age matched normal subjects (n = 20, mean age 67 years). Flexible electrogoniometry was used to record the maximum flexion-extension angle, the minimum flexion-extension angle and flexion-extension excursions of both knees during eleven functional activities along with the active and passive knee joint range of motion measured using a manual goniometer. Over the eleven functional activities the patients pre-operatively exhibited 28% less knee joint excursion than normal age matched subjects. By 18-24 months following total knee arthroplasty only 2% of this deficit was recovered. Statistically this recovery was only significant in level walking, slope ascent and slope descent. A greater range of movement was measured in a non-weight bearing position than was used in weight bearing functional activity. It is concluded that total knee arthroplasty gives rise to little improvement in knee motion during functional activities and that functional range of movement of the knee remains limited when compared to normal knee function for a minimum of 18 months following operation.     

Dislocation of the polyethylene inlay due to anterior tibial slope in revision total knee arthroplasty

We report a case of dislocation of the polyethylene inlay in revision total knee arthroplasty. Eight days after revision arthroplasty due to a previous infection, the polyethylene inlay of a PCL- retaining cemented total knee arthroplasty dislocated at about 80 degrees of flexion on the CPM machine. Lateral X-ray examination revealed an anterior slope of the tibial cut of 5 degrees. Correction of the tibial slope to a posterior tibial slope of 7 degrees reduced the forces on the posterior aspect of the inlay and no redislocation occurred. The mechanisms causing tibial inlays to dislocate in TKA are analyzed and discussed.     

Static progressive stretch improves range of motion in arthrofibrosis following total knee arthroplasty

Arthrofibrosis is a relatively common complication after total knee arthroplasty that negatively affects function and quality of life. Static progressive stretching is a technique that has shown promising results in the treatment of contractures of the elbow, ankle, wrist and knee. This study evaluated a static progressive stretching device as a treatment method for patients who had refractory knee stiffness after total knee arthroplasty. Twenty-five patients who had knee stiffness and no improvement with conventional physical therapy modalities were treated with the device. After a median of 7 weeks (range, 3–16 weeks), the median increase in range of motion was 25° (range, 8–82°). The median gain in knee active flexion was 19° (range, 5–80°). Ninety-two percent of patients were satisfied with the results. The authors believe static progressive stretching devices may be an effective method for increasing the ranges of motion and satisfaction levels of patients who develop arthrofibrosis after total knee arthroplasty.     

Early knee motion after open and arthroscopic anterior cruciate ligament reconstruction

The hypothesis proposed in this study was that the initiation of active and passive knee motion within 48 hours of major intraarticular knee ligament surgery would not have the deleterious effects of increasing knee effusion, hemarthrosis, periarticular soft tissue edema, and swelling. We conducted a prospective study with randomized assignment of 18 patients into two groups: 9 patients in the "motion" group began 10 hours of daily continuous passive motion (CPM) on the 2nd postoperative day, while the remaining 9 in the "delayed motion" group used a soft hinged knee brace with knee hinges locked at 10 degrees of flexion and entered into the motion program on the 7th postoperative day. All knees were allowed full 0 degrees to 90 degrees of motion except for a total of seven knees with concomitant mensicus repairs and extraarticular reconstructions where 20 degrees to 90 degrees of motion was allowed, limiting the last 20 degrees of knee extension for the first 4 postoperative weeks to protect the repair. In all other respects, the rehabilitation program after surgery was the same for the two groups, including postoperative compression dressings, exercises, and weight-bearing status. Ten of the eighteen patients had acute ACL disruptions and 8 had chronic ACL insufficiencies. There was an even distribution of acute and chronic knee cases and of open and arthroscopic ligament procedures in the early and delayed motion groups. Associated surgery included four meniscus repairs, three medial collateral ligament repairs, and one lateral collateral ligament repair. Special suturing and fixation techniques were used at surgery to maintain the integrity of ligament and meniscus structures, allowing the surgeon to feel safe in subjecting the joint to early postoperative motion. The objective parameters measured were KT-1000 arthrometer measurements, Cybex isokinetic testing, girth measurements at four lower limb locations, range of motion goniometer measurements, postoperative pain medications, and days of hospitalization. Starting intermittent passive motion on the 2nd postoperative day did not increase joint effusion, hemarthrosis, or soft tissue swelling. In both motion groups, postoperative joint effusions were absent after the 14th postoperative day. There was no statistically significant difference in knee extension or flexion limits, pain medication used, or hospital stay in comparing the two knee motion programs. An important finding of this study was the significant decreases in thigh circumference that occurred within the first few weeks of surgery, which progressed despite a closely supervised inpatient and outpatient rehabilitation program.(ABSTRACT TRUNCATED AT 400 WORDS)     

Lower extremity gait kinematics outcomes after knee replacement demonstrate arthroplasty-specific differences between unicondylar and total knee arthroplasty: A pilot study

BackgroundThe aim of the present study is to compare sagittal gait kinematics of ankle, knee and hip joints between subjects with unicondylar and total knee arthroplasty and age matched healthy controls. Since unicondylar knee replacement is a less invasive procedure, which more closely preserves knee joint anatomy, we hypothesized that one year post unicondylar knee arthroplasty patients would demonstrate more normal gait patterns than patients with total knee arthroplasty.Research questionDo unicondylar and total knee arthroplasty patients display similar gait kinematics one year after surgery?MethodsFourteen subjects (8 posterior stabilized and 6 medial unicondylar knee replacements) that were one year post surgery, and 6 healthy control subjects underwent a 3D gait analysis and a physical examination (range of motion, muscle strength). Statistical parametric mapping was used to compare gait kinematics of the lower limbs between groups. Additionally, differences in peak angles and clinical outcomes were assessed using a one-way ANOVA between subjects analysis.ResultsBoth knee replacement groups showed reduced knee flexion range of motion and reduced muscle strength at the operated leg compared to the control group. Subjects with TKA demonstrated reduced knee flexion at loading response and midstance of the gait cycle. Both UKA and TKA demonstrated significantly less knee flexion during swing.SignificanceThe results of this study demonstrate arthroplasty-specific differences in muscle strength, range of motion and gait kinematics of the lower limb one year after knee surgery. Future planning of post-surgery follow-up should addresses these arthroplasty-specific weaknesses and gait deviations.