膝关节周围骨折术后早期应用CPM装置的临床研究

发布时间：2018-05-13 09:35

本文选题：CPM + 膝关节周围骨折　；参考：《苏州大学》2015年硕士论文

【摘要】：目的:膝关节周围骨折是临床上常见病,常发生在交通伤、运动损伤、坠落伤及老年性骨质疏松。此类骨折发生后,常常需要手术治疗,而术后的关节功能康复训练尤为重要,是避免关节周围粘连、关节僵硬、强直的有效手段。CPM作为关节康复手段之一,应用广泛、疗效满意,但近年来一些临床研究表明,CPM在膝关节损伤患者的关节功能恢复中并无益处。本文通过对膝关节周围骨折术后早期应用CPM机进行患膝被动功能锻炼,评估膝关节康复情况,探讨CPM对膝关节功能恢复的影响,从而评价CPM机的康复效果和临床使用价值,不断优化康复治疗,提高膝关节康复效率,促进关节功能恢复。方法:回顾性分析自2013年1月至2014年6月在苏州市中西医结合医院骨科诊治的53例无合并症的新鲜、单侧膝关节周围骨折病例,伤前均可独立行走。入院后,患者均行切开复位内固定术,内固定坚强,关节复位均为解剖复位,术后患肢均未行外固定制动。按照不同康复训练方式,分为CPM组和对照组例。CPM组共26例,男性15例,女性11例,平均年龄50.15±12.58岁,术后第2天起进行CPM机功能锻炼,每日锻炼2次,每次2小时,起始角度为30°,至术后2周,逐渐增加至90°;同时,此组患者自术后第1天起进行股四头肌等长收缩、踝关节伸屈活动、膝关节伸屈运动等主动功能锻炼。对照组共27例,男性12例,女性15例,平均年龄49.04±11.41,进行同CPM组相同的主动功能锻炼,直至术后2周,但不进行CPM机锻炼。分别比较两组病例在术后1、2、6周、3月及6月术后并发症情况、骨折愈合情况、内固定在位情况及膝关节伸屈角度;比较两组患者在术后3月、6月AKS膝关节评分;比较两组患者术后1周、2周时VAS疼痛评分及每位患者各自患侧小腿周径与健侧小腿周径的差值。结果:术后第1、2、6周、3月、6月对两组患者术后并发症、骨折愈合情况、内固定在位情况比较,差异无统计学意义。术后第1、2、6周、3月、6月对两组患者的膝关节活动度进行评定:伸直角度比较,差异无统计学意义(P0.05);屈曲角度比较,CPM组术后第1、2、6周、3月均优于对照组(P0.05),而术后6月,两组病例比较,差异无统计学意义(P0.05)。AKS膝关节评分比较,术后3月优良率CPM组为88.5%,对照组为63.0%,CPM组优于对照组(P0.05);术后6个月优良率CPM组为96.15%,对照组为96.29%,组间比较差异无统计学意义(P0.05)。术后1、2周,CPM组VAS疼痛评分优于对照组(P0.05)。术后1、2周,两组患者各自患、健两侧小腿周径的差值比较,CPM组优于对照组(P0.05)。结论:膝关节周围骨折术后早期应用CPM机,加快恢复膝关节活动度,促进肿胀消退,缓解患者疼痛,提高患者主动锻炼的积极性,对膝关节功能更好、更快恢复有重要的临床意义。
[Abstract]:Objective: periarticular fracture is a common disease, often occurring in traffic injury, sports injury, falling injury and senile osteoporosis. After the occurrence of this kind of fracture, surgical treatment is often required, and postoperative rehabilitation training of joint function is particularly important. CPM is an effective means to avoid adhesion, stiffness and ankylosis around the joint. CPM is widely used as one of the rehabilitation methods of joint. The curative effect is satisfactory, but in recent years, some clinical studies have shown that CPM is not beneficial in the recovery of joint function in patients with knee joint injury. In order to evaluate the effect of CPM on the rehabilitation of knee joint and evaluate the clinical application value of CPM machine, the passive function exercise of affected knee was carried out by using CPM machine in the early postoperative period after knee joint fracture, and the rehabilitation condition of knee joint was evaluated, and the effect of CPM on the recovery of knee joint function was discussed. Continuous optimization of rehabilitation treatment, improve the efficiency of knee rehabilitation, promote the recovery of joint function. Methods: from January 2013 to June 2014, 53 cases of fresh and unilateral peri-knee fractures diagnosed and treated in orthopedic department of Suzhou Integrated Chinese and Western Medicine Hospital were analyzed retrospectively. After admission, all patients were treated with open reduction and internal fixation, internal fixation was firm, joint reduction was anatomic reduction, and no external fixation and immobilization was performed in all the affected limbs after operation. According to the different rehabilitation training methods, 26 cases were divided into CPM group and control group. There were 15 males and 11 females with an average age of 50.15 卤12.58 years. CPM machine function exercise was performed on the second day after operation, 2 hours per day. The initial angle was 30 掳, and gradually increased to 90 掳from 2 weeks after operation. At the same time, the patients in this group underwent quadriceps equal-length contraction, extension and flexion of ankle joint, extension and flexion of knee joint and other active function exercises from the first day after operation. There were 27 patients in the control group, 12 males and 15 females, with an average age of 49.04 卤11.41. The patients were treated with the same active function exercise as the CPM group until 2 weeks after operation, but no CPM machine exercise was performed. The postoperative complications, fracture healing, internal fixation in position and knee extension and flexion angle were compared between the two groups at 1 ~ 2 weeks, 3 and 6 months postoperatively, and the AKS knee joint score was compared at 3 and 6 months after operation. The VAS pain score and the difference between each patient's leg circumference and that of the healthy leg were compared between the two groups at 1 week and 2 weeks after operation. Results: there was no significant difference in postoperative complications, fracture healing and internal fixation in 6 weeks, 3 months and 6 months after operation. The knee joint motion of the two groups was evaluated at the 1st week, 2nd week, 3rd month and 6th month after operation: there was no significant difference in straightening angle between the two groups, and the flexion angle was higher in the CPM group than in the control group at 2 ~ 6 weeks postoperatively, but in 6 months after operation, there was no significant difference between the two groups, and there was no significant difference between the two groups at 6 months after operation. There was no significant difference in knee joint score between the two groups. The excellent and good rate was 88.5 in the CPM group and 63.0 in the control group, but the excellent and good rate was 96.15 in the CPM group and 96.29 in the control group at 6 months after operation. There was no significant difference between the two groups. The pain score of VAS in CPM group was better than that in control group at 1 and 2 weeks postoperatively (P 0.05). At 1 and 2 weeks after operation, the difference between the two groups was better than that in the control group (P 0.05), and the difference between the two groups was better than that in the control group (P 0.05). Conclusion: early application of CPM machine can accelerate the recovery of knee joint motion, promote swelling, relieve pain, improve the enthusiasm of active exercise, and improve the function of knee joint. Faster recovery has important clinical significance.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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