摘要
目的:探讨严重畸形膝关节置换围手术期康复方法。方法:①对象:选择2005-09/2007-02呼伦贝尔市医院骨科收治的严重风湿病下肢关节畸形施行膝关节置换术患者20例24膝。②干预:对膝内翻患者主要以训练关节活动度和增强肌力为主;对膝外翻患者,主要以增强肌力为主,必要时用支具保护;骨质疏松者康复锻炼以被动活动缓慢过渡到主动活动、由小量短时间逐渐加大运动量并延长康复周期的方法;残余屈曲挛缩畸形主要以手法按压为主。③评估:于手术前、术后2周、1个月及3个月,对患者膝关节平均HSS(纽约特种外科医院)评分及平均活动度进行对比观察,并对术后疼痛、患肢功能及主观满意度进行评估。结果:除1例1膝失访,19例患者顺利度过围手术期康复治疗。①患者膝关节活动度术前平均的35.2°,术后2周提高到92.5°。②HSS评分术前39.1分,术后2周提高到94.1分;平均股四头肌肌力较术前提高1.3级。③患者术后疼痛症状明显缓解,出院时所有患者不扶拐行走距离均超过100m。1个月、3个月随访结果满意,无并发症发生。结论:严重膝关节畸形关节置换的围手术期康复应根据术前关节畸形状态、骨质条件、术中软组织松解范围及截骨情况术后针对性的进行康复锻炼。康复应采取个体化、循序渐进及随时调整的原则进行。
AIM：To investigate rehabilitation in peri-operative period of total knee arthroplasty （TKA） with severe knee defornlity. METHODS： （1）From September 2005 to February 2007, 20 cases （24 knees） with lower limb joint deformity induced by severe rheumatism were enrolled from Department of Orthopaedics in Hulun Buir Hospital. （2） For varus knees, rehabilitation aimed at range of motion （ROM） and muscle strength. For valgus knees, muscle strength exercise was emphasized with brace. For osteoporosis, rehabilitation exercise was done from passiveness to initiative, from little quantity of motion to more extensive and prolonged rehabilitation period. For remained flexion deformity, manipulating massage was used. （3）Pre-operation, and 2 weeks, 1 month, 3 months postoperation, average scores of hospital for special surgery （HSS） and average ROM were used to evaluate the knee joints of patients. Postoperative pain, function of injured knee and subjective satisfactory degree were also determined. RESULTS： Except one case （one knee） was lost, other 19 patients were involved in the result analysis.（1）Average ROM was improved from 35.2° pre-operatively to 92.5° 2 weeks postoperatively.（2）Average HSS score was improved from 39.1 points pre-operatively to 94.1 points 2 weeks postoperatively. Average muscle strength of quadriceps femoris was improved 1.3 grades.（3）Postoperative pain was relieved obviously, and all the patients could walk without brace for more than 100 m. The outcomes of follow-up for 1, 3 months were all satisfactory, and no complications appeared. CONCLUSION： Rehabilitation in peri-operative period of TKA for severe knee deformity should be made according to deformity status, bone condition, soft tissue releasing during operation and bone cutting. The rehabilitation plane should be individualized, progressive and adjustable.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2007年第41期8368-8371,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
