全膝关节置换术后主动和被动锻炼促进关节功能恢复的前瞻性研究

目的 探讨全膝关节置换(TKA)术后持续被动活动和主动功能锻炼对患者关节功能康复效果的影响. 方法采用前瞻性研究方法,选取2007年2月至2008年6月行TKA的80例患者为研究对象,所有患者按入院序号应用随机数字表法分为持续被动活动组(CPM组)和主动功能锻炼组(AP组),每组40例.CPM组术后早期应用CPM机行康复治疗,AP组则在专业康复医师指导下进行主动功能锻炼.记录患者术后第3、6、9天时的VAS评分,术后第3、6、9天、出院及随访时的关节活动度,患者住院天数.采用美国膝关节外科学会的评分系统(KSS)对患者术前、术后3、6个月随访时的患膝关节功能进行评分. 结果术后第3天,CPM组、AP组的平均VAS评分分别为2.37、3.02分,差异有统计学意义(t=-2.52,P=0.03).术后第6、9天两组患者平均VAS评分差异均无统计学意义(P>0.05).术后3、6、9 d及出院时两组患者的关节活动度差异均无统计学意义(P>0.05).56例患者(CPM组30例,AP组26例)获得随访.术后3个月,CPM组、AP组患者的关节活动度为别为105.50°、112.96°,差异有统计学意义(P=0.04),但术后6个月时两组差异无统计学意义(P>0.05).术后3、6个月两组患者KSS评分差异均无统计学意义(P>0.05). 结论 TKA术后功能恢复应强调主动功能锻炼而非被动锻炼.不推荐常规应用CPM,但对痛觉过敏及无法进行主动功能锻炼的患者,仍应考虑CPM辅助治疗,以促进关节功能的恢复.

Effects of postoperative active and passive exercises on functional recovery after TKA

Objective To observe the differences in functional recovery between active physiother-apy (AP) and continuous passive motion (CPM) after total knee arthroplasty (TKA). Methods Eighty cases of TKA patients were randomly divided into 2 even groups of CPM and AP. In the CPM group, CPM devices were applied in the early days postoperatively; in the AP group, active exercise was encouraged under guidance of rehabilitation physicians. The visual pain scores (VAS) at the 3, 6, 9 days after operation, ranges of motion (ROM) at different time points, and duration of hospitalization were documented for each patient. Results At the third day after operation, CPM group got less VAS than AP group (P < 0.05) . There were no significant differences between the 2 groups in ROM at 3, 6 and 9 days after surgery respec-tively (P > 0.05). The follow-ups of 56 patients at 3 and 6 months after operation revealed that the average ROM of AP group was significantly greater than that of CPM group (P < 0.05). Conclusions AP rather than CPM should be recommended in the rehabilitation for patients after TKA. But CPM can be considered for patients with hyperalgesia or those who are unable to take active exercise to accelerate functional recovery.