重度屈曲畸形膝关节置换术后康复效果研究

目的评价类风湿性关节炎伴膝关节重度屈曲畸形患者行人工膝关节置换术后康复措施的临床效果。 方法回顾性分析2013年6月至2017年9月收治的21例(36膝)类风湿性关节炎伴膝关节重度屈曲畸形患者在人工膝关节置换术后进行功能康复治疗的疗效情况。纳入标准为类风湿关节炎伴膝关节屈曲挛缩角度达60°以上患者，排除标准为存在其它继发性膝骨关节炎者。对所有患者实施系统康复治疗。评估术后、康复出院时以及末次随访的疼痛视觉模拟评分(VAS评分)，膝关节屈曲挛缩角度以及膝关节活动范围，进而评估术后康复措施的疗效。根据数据是否符合正态分布，多组间定量资料比较采用单因素方差分析或Friedman秩和检验。 结果在21例患者中，15例(26膝)获得随访，随访时间平均(46±15)个月。术后膝关节VAS评分中位数为7(6，8)分，康复出院时为2(2，3)分，末次随访为0(0，1.7)分，3个时间点的VAS评分组间差异有统计学意义(P<0.001)。术后膝关节屈曲挛缩角度平均为(30±13)°，康复出院时(8±5)°，末次随访为(7±10)°，3个时间点屈曲挛缩角度差异有统计学意义(F＝57.4，P<0.001)。术后膝关节活动范围为(56±21)°，康复出院时(99±11)°，末次随访(88±18)°，3个时间点膝关节活动范围差异有统计学意义(F＝53.8，P<0.001)。 结论类风湿关节炎伴膝关节重度屈曲挛缩畸形的患者行人工膝关节置换术后，经过功能康复治疗后，可实现膝关节功能的改善。

Effect of functional rehabilitation of rheumatoid arthritis patients with severe flexion contracture after knee replacement

ObjectiveTo investigate the effect of knee rehabilitation training after total knee arthroplasty in rheumatoid arthritis knees with severe flexion contracture. MethodsA retrospective analysis of 21 cases (36 knees) of rheumatoid arthritis with severe flexion contracture of knee joint over 60 degrees from June 2013 to September 2017 was carried out.The patients with other secondary knee osteoarthritis were excluded. Patients were performed rehabilitation treatments after total knee replacement. The visual analog pain score, flexion contracture and range of motion of knee were evaluated before and after operation, at discharge and at the last follow-up. The comparison between groups was tested by One-way ANOVA or Friedman test depending on their distribution. ResultsFifteen (26 knees) of 21 patients were followed up for an average of (46±15) months. The median VAS score of knee joint was 7(6, 8) after operation, 2(2, 3) at discharge, and 0(0, 1.7) at the last follow-up. The difference of VAS at three time points was highly statistically significant(P<0.001). The average knee flexion contracture angle were (30±13)° after operation, (8±5)° at discharge and (7±10)° at the last follow-up. The analysis of variance showed that there were significant differences in the range of motion among time points (F=57.4, P<0.001). The average range of motion of the joint was (56±21)° after operation, (99±11)° at discharge and (88±18)°at the last follow-up. The analysis of variance showed that there was a significant difference in the range of motion between the four time points (F=53.8, P<0.001). ConclusionSeries of rehabilitation measures following joint replacement can improve the knee function of rheumatoid arthritis patients with severe flexion contracture.