全膝置换后早期持续主动功能锻炼有利于关节功能的恢复

背景：人工全膝关节置换后早期进行康复功能锻炼,可以最大限度改善膝关节功能。目的：观察主动和被动功能锻炼对全膝置换后早期关节功能恢复的影响。方法：将226例全膝关节置换患者随机分为2组,置换后分别使用可控主动运动夹板和持续性被动运动器进行关节功能康复,置换后1.5,3,6个月记录两组关节活动度、术后疼痛目测类比VAS评分及KSS功能评分。结果与结论：置换后3个月可控主动运动组KSS功能评分优于持续性被动运动组,置换后6个月两组间KSS功能评分差异无显著性意义;置换后1.5,3个月可控主动运动组关节活动度优于持续性被动运动组,置换后6个月两组间差异无显著性意义。提示全膝关节置换后使用可控主动运动夹板进行功能训练,可以促进膝关节功能早期恢复。     

全膝人工关节置换术患者早期功能锻炼效果观察

目的观察全膝人工关节置换术患者早期功能锻炼的效果。方法将2000年1月～2002年6月行全膝人工关节置换术患者35例(40个膝)为观察组,1997年1月～1999年12月行全膝人工关节置换术患者30例(31个膝)为对照组。观察组术后进行早期有计划的功能锻炼,对照组术后按常规进行功能锻炼。经6个月随访,分别对两组患肢膝关节功能恢复进行评分,经统计学分析。结果两组患者膝关节功能优良率比较经字2检验,字2=7.70,P<0.05,有显著性差异。结论人工全膝关节置换术后早期功能锻炼可提高膝关节活动度,有效防止关节僵硬,促进膝关节功能恢复。     

早期大角度被动锻炼对全膝置换术后膝关节活动度的影响

目的探讨全膝置换术（TKA）后早期大角度被动锻炼对膝关节活动度的影响。方法将89例行全膝置换术（TKA）后的患者随机分为早期大角度被动活动组（大角度组）和常规被动活动组（常规组）,所有患者均接受骨科常规治疗、护理和功能锻炼指导。大角度组术后2周内的被动屈曲功能锻炼角度比对照组大（以患者的耐痛能力为限）。结果两组患者术后第1,2,3,4周AKS评分比较差异具有统计学意义（t=3．31,7．65,7．78,7．36;P〈0．05）。两组患者术后第1,2,3,4周ROM评分比较差异具有统计学意义（t=26．22,26．08,30．67,33．69;P〈0．05）。结论全膝关节置换（TKA）术后应尽早进行科学合理的功能康复锻炼,有利于膝关节功能的恢复,对于提高术后的活动度和关节功能具有较好的促进作用。     

全膝表面关节置换术后影响关节活动度的相关因素

全膝人工关节置换术在临床上已获得广泛应用，它可减轻疼痛，改善膝关节活动度，尽可能恢复关节功能，但对关节活动的改善程度、疗效不确定。     

早期大角度被动ROM练习对全膝置换术后膝关节功能的影响

目的:观察全膝置换术(TKA)后早期大角度膝关节被动活动度(ROM)练习与常规被动ROM练习对TKA后膝关节功能改善的影响。方法:将34例老年骨性关节炎(OA)患者按手术顺序随机分成术后常规被动ROM练习组和大角度被动ROM练习组。所有患者均由同一术者用微创全膝置换术式(MIS-TKA)进行手术。大角度被动ROM组在术后2周内的被动ROM练习角度比常规被动ROM练习组大20°—30°,其他康复方案和术后镇痛方案均相同。结果:两组患者术前HSS评分差异无显著性,但术后第1、2、6、12和24周大角度被动ROM练习组的HSS评分均高于常规被动ROM练习组。其中,术后第1、2周的HSS差异有显著性(P<0.05)。两组患者的术前膝关节主动和被动ROM差异均无显著性,但术后第4天、1周、2周、6周、12周、24周膝的主动和被动ROM差异均有显著性意义(P<0.05)。结论:对MIS-TKA患者术后早期大角度被动ROM练习不仅能改善患膝的主动和被动ROM,还能改善膝HSS功能评分。     

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。     

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.     

同期双侧全膝关节置换与选择性单侧全膝关节置换后的早期功能恢复

背景:同期双侧全膝关节置换与选择性单侧全膝关节置换后的早期功能恢复一直存在着争议。目的:评价双膝骨关节炎患者同期双侧全膝关节置换与选择性单侧全膝关节置换后功能恢复情况的差异。方法:根据置换方案将初次行全膝关节置换的双膝骨关节炎患者86例(116膝)分为两组,双膝组(n=29,58膝)行同期双侧全膝关节置换,单膝组(n=57,57膝)行单侧全膝关节置换。分别对两组患者置换前后的关节活动度、屈曲挛缩度、肌力、疼痛评分、双下肢不等长及HSS评分进行比较分析,并记录并发症的发生率。结果与结论:置换后1年随访,两组患者置换后关节活动度和肌力差异无显著性意义(P=0.171,0.418);置换后屈曲挛缩度、疼痛评分及双下肢不等长双膝组均显著低于单膝组(P=0.006,0.0013,0.026);同时双膝组置换后HSS评分优于单膝组(P=0.003)。提示同期双侧全膝关节置换患者在屈曲挛缩度、疼痛症状评分、双下肢不等长及HSS评分方面优于单侧全膝关节置换,而两种方案在置换后关节活动度和下肢肌力方面无明显差异。     

同期双侧全膝关节置换与选择性单侧全膝关节置换后的早期功能恢复

背景：同期双侧全膝关节置换与选择性单侧全膝关节置换后的早期功能恢复一直存在着争议。目的：评价双膝骨关节炎患者同期双侧全膝关节置换与选择性单侧全膝关节置换后功能恢复情况的差异。方法：根据置换方案将初次行全膝关节置换的双膝骨关节炎患者86例（116膝）分为两组,双膝组（n=29,58膝）行同期双侧全膝关节置换,单膝组（n=57,57膝）行单侧全膝关节置换。分别对两组患者置换前后的关节活动度、屈曲挛缩度、肌力、疼痛评分、双下肢不等长及HSS评分进行比较分析,并记录并发症的发生率。结果与结论：置换后1年随访,两组患者置换后关节活动度和肌力差异无显著性意义（P=0.171,0.418）;置换后屈曲挛缩度、疼痛评分及双下肢不等长双膝组均显著低于单膝组（P=0.006,0.0013,0.026）;同时双膝组置换后HSS评分优于单膝组（P=0.003）。提示同期双侧全膝关节置换患者在屈曲挛缩度、疼痛症状评分、双下肢不等长及HSS评分方面优于单侧全膝关节置换,而两种方案在置换后关节活动度和下肢肌力方面无明显差异。     

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。     

Continuous passive motion after total knee arthroplasty

We established a clinical retrospective study to determine the benefit of continuous passive motion after total knee replacement. Nineteen patients who had continuous passive motion (CPM) after total knee replacement were compared to a control group of 15 patients who did not have CPM. The number of days to discharge was 16 for the CPM group and 20 for the control group. When the patients with complications from CPM were excluded from the CPM group, the average number of days to discharge for the CPM group was 12. The average number of postoperative days before reaching 90 degrees of knee flexion was nine in the CPM group as compared to 16 days in the control group. The average blood loss was not significantly different in the two groups. There were four wound healing complications in the CPM group. All four complications occurred in patients who achieved 90 degrees of knee flexion in less than six days postoperatively. We developed a protocol for maximal use of CPM without significant wound complications after total knee surgery.     

Aggressive continuous passive motion exercise does not improve knee range of motion after total knee arthroplasty

Aims and objectives. The aim of this study was to evaluate the effects of continuous passive motion on the range of motion, postoperative pain and life quality of patients undergoing total knee arthroplasty within six months after the operation. Background. Total knee arthroplasty reduces pain and improves range of motion of the osteoarthritic knee joint. Continuous passive motion increases postoperative movement, but there is some controversy regarding whether aggressive continuous passive motion can improve range of motion or life quality, and whether it induces more pain. Design. A prospective controlled study was conducted in a medical centre in Taiwan from January to December 2006. Methods. One hundred and seven patients were recruited. The patients underwent the basic rehabilitation protocols (the control group) or the basic rehabilitation protocols and additional daily use of continuous passive motion for more than six hours per day (the experimental group). The range of motion, modified Short Form‐36 (SF‐36) and semi‐quantitative visual analogue scale were recorded. Results. Range of motion increased from 109° preoperatively to 125° at six months postoperatively in the treatment group and from 111° preoperatively to 125° at six months postoperatively in the control group. Visual analogue scale decreased from 7·78 preoperatively to 0·37 at six months postoperatively in the treatment group and from 7·92 preoperatively to 0·21 at six months postoperatively in the control group. The SF‐36 improved from 3·76 preoperatively to 1·77 at six months postoperatively in the treatment group and from 3·68 preoperatively to 1·83 at six months postoperatively in the control group. There was no significant difference in range of motion, visual analogue scale and SF‐36 between groups at each visit. Conclusion. With the advances in total knee arthroplasty surgical technique, aggressive continuous passive motion does not provide obvious benefits. Relevance to clinical practice. Total knee arthroplasty can alleviate pain and improve range of motion, but aggressive continuous passive motion does not provide additional benefits.     

CPM机在全膝关节表面置换术后康复训练中应用最佳时间的研究

目的研究CMP机在TKA术后康复训练中的最佳应用时间。方法选取2009年1月-2013年1月因膝关节骨性关节炎在我院接受TKA的80例患者为研究对象。将80例患者随机分为四组。对照组为TKA术后未应用CPM机进行康复训练组(20例);观察组为TKA术后应用CPM机康复训练组,共三组,分别为术后即刻应用组(20例)、拔除引流管后应用组(20例)、术后1周应用组(20例)。观察术后两周各组膝关节KSS评分、切口愈合不良发生率,术后1个月、1年膝关节KSS评分。结果与对照组相比,观察组各组切口愈合不良发生率无统计学意义(P0.05)。与对照组相比,观察组各组术后两周膝关节KSS评分明显提高(P0.01),CPM机使用时间越早膝关节KSS评分越高;术后1个月、1年观察组各组膝关节KSS评分较对照组高(P0.01),但组间无统计学意义(P0.05)。结论 TKA术后的康复训练,配合CPM机应用时间越早越好。CPM机的应用,有利于促进膝关节功能的恢复,同时不会增加切口愈合不良发生率。     

持续被动活动在全膝关节成形术后康复中的应用研究

从持续被动活动(CPM)在全膝关节成形术(TKA)后早期功能锻炼中的作用、应用效果及方案的制定方面,对CPM在TKA术后中应用现状进行综述。     

Continuous passive motion after total knee arthroplasty: a prospective study

OBJECTIVE: Continuous passive motion (CPM) has been shown to increase significantly the amount of knee flexion for patients with total knee arthroplasty in the acute care hospital. Whether there is any additional benefit to using CPM for these patients who are transferred to a rehabilitation hospital is not known. There have been no prospective, randomized, controlled studies in this area. DESIGN: Fifty-one such patients on an inpatient rehabilitation service were randomly assigned to two groups. Group 1 (n = 23) received CPM for 5 consecutive hours per day plus physical therapy, whereas group 2 (n = 28) received only physical therapy. Knee flexion was measured by a blinded physical therapist on admission, on the third and seventh days of hospitalization, and at the time of discharge. RESULTS: The results indicated no significant difference in passive range of motion between group 1 and group 2. Patients in group 1 achieved an average increase in passive range of motion of 16 degrees, whereas those in group 2 achieved an average of 19 degrees (P = 0.33). CONCLUSION: Although power analysis indicated the need for differences in results for 32 patients per group to achieve significance, the difference between the two groups suggested neither statistical nor clinical significance. We concluded that the use of CPM in the rehabilitation hospital is likely of no added benefit to patients admitted after single total-knee replacement.     

人工膝关节置换与围手术期系统康复

目的:探讨围手术期系统康复对人工膝关节置换术后效果的影响.方法:收集中国期刊全文数据库1996-01/2006-12及PUBMED1996-01/2006-12有关人工膝关节置换围手术期系统康复的文献,对系统关节功能训练方法及其对人工膝关节置换手术效果的影响进行综合分析.结果:术前教育、关节活动度训练、肌力训练、本体感觉训练及行走步态训练是人工膝关节置换术围手术期系统康复的最重要的内容.人工膝关节置换术患者经过系统规范的围手术期康复治疗:其术后膝关节的关节活动度、下肢肌肉力量、行走时的步态及本体感觉等诸多方面均能够在短时间内恢复正常.结论:人工膝关节置换围手术期系统康复治疗对于手术后的临床效果至关重要,是术后膝关节功能达到预期效果的重要措施.     

Effectiveness of continuous passive motion and conventional physical therapy after total knee arthroplasty: a randomized clinical trial

BACKGROUND AND PURPOSE: This randomized clinical trial was conducted to compare the effectiveness of 3 in-hospital rehabilitation programs with and without continuous passive motion (CPM) for range of motion (ROM) in knee flexion and knee extension, functional ability, and length of stay after primary total knee arthroplasty (TKA). SUBJECTS: Eighty-one subjects who underwent TKA for a diagnosis of osteoarthritis were recruited. METHODS: All subjects were randomly assigned to 1 of 3 groups immediately after TKA: a control group, which received conventional physical therapy intervention only; experimental group 1, which received conventional physical therapy and 35 minutes of CPM applications daily; and experimental group 2, which received conventional physical therapy and 2 hours of CPM applications daily. All subjects were evaluated once before TKA and at discharge. The primary outcome measure was active ROM in knee flexion at discharge. Active ROM in knee extension, Timed "Up & Go" Test results, Western Ontario and McMaster Universities Osteoarthritis Index questionnaire scores, and length of stay were the secondary outcome measures. RESULTS: The characteristics of and outcome measurements for the subjects in the 3 groups were similar at baseline. No significant difference among the 3 groups was demonstrated in primary or secondary outcomes at discharge. DISCUSSION AND CONCLUSION: The results of this study do not support the addition of CPM applications to conventional physical therapy in rehabilitation programs after primary TKA, as applied in this clinical trial, because they did not further reduce knee impairments or disability or reduce the length of the hospital stay.