本文選題：CPM + 膝關(guān)節(jié)周圍骨折　； 參考：《蘇州大學(xué)》2015年碩士論文

【摘要】：目的:膝關(guān)節(jié)周圍骨折是臨床上常見病,常發(fā)生在交通傷、運(yùn)動損傷、墜落傷及老年性骨質(zhì)疏松。此類骨折發(fā)生后,常常需要手術(shù)治療,而術(shù)后的關(guān)節(jié)功能康復(fù)訓(xùn)練尤為重要,是避免關(guān)節(jié)周圍粘連、關(guān)節(jié)僵硬、強(qiáng)直的有效手段。CPM作為關(guān)節(jié)康復(fù)手段之一,應(yīng)用廣泛、療效滿意,但近年來一些臨床研究表明,CPM在膝關(guān)節(jié)損傷患者的關(guān)節(jié)功能恢復(fù)中并無益處。本文通過對膝關(guān)節(jié)周圍骨折術(shù)后早期應(yīng)用CPM機(jī)進(jìn)行患膝被動功能鍛煉,評估膝關(guān)節(jié)康復(fù)情況,探討CPM對膝關(guān)節(jié)功能恢復(fù)的影響,從而評價CPM機(jī)的康復(fù)效果和臨床使用價值,不斷優(yōu)化康復(fù)治療,提高膝關(guān)節(jié)康復(fù)效率,促進(jìn)關(guān)節(jié)功能恢復(fù)。方法:回顧性分析自2013年1月至2014年6月在蘇州市中西醫(yī)結(jié)合醫(yī)院骨科診治的53例無合并癥的新鮮、單側(cè)膝關(guān)節(jié)周圍骨折病例,傷前均可獨(dú)立行走。入院后,患者均行切開復(fù)位內(nèi)固定術(shù),內(nèi)固定堅強(qiáng),關(guān)節(jié)復(fù)位均為解剖復(fù)位,術(shù)后患肢均未行外固定制動。按照不同康復(fù)訓(xùn)練方式,分為CPM組和對照組例。CPM組共26例,男性15例,女性11例,平均年齡50.15±12.58歲,術(shù)后第2天起進(jìn)行CPM機(jī)功能鍛煉,每日鍛煉2次,每次2小時,起始角度為30°,至術(shù)后2周,逐漸增加至90°;同時,此組患者自術(shù)后第1天起進(jìn)行股四頭肌等長收縮、踝關(guān)節(jié)伸屈活動、膝關(guān)節(jié)伸屈運(yùn)動等主動功能鍛煉。對照組共27例,男性12例,女性15例,平均年齡49.04±11.41,進(jìn)行同CPM組相同的主動功能鍛煉,直至術(shù)后2周,但不進(jìn)行CPM機(jī)鍛煉。分別比較兩組病例在術(shù)后1、2、6周、3月及6月術(shù)后并發(fā)癥情況、骨折愈合情況、內(nèi)固定在位情況及膝關(guān)節(jié)伸屈角度;比較兩組患者在術(shù)后3月、6月AKS膝關(guān)節(jié)評分;比較兩組患者術(shù)后1周、2周時VAS疼痛評分及每位患者各自患側(cè)小腿周徑與健側(cè)小腿周徑的差值。結(jié)果:術(shù)后第1、2、6周、3月、6月對兩組患者術(shù)后并發(fā)癥、骨折愈合情況、內(nèi)固定在位情況比較,差異無統(tǒng)計學(xué)意義。術(shù)后第1、2、6周、3月、6月對兩組患者的膝關(guān)節(jié)活動度進(jìn)行評定:伸直角度比較,差異無統(tǒng)計學(xué)意義(P0.05);屈曲角度比較,CPM組術(shù)后第1、2、6周、3月均優(yōu)于對照組(P0.05),而術(shù)后6月,兩組病例比較,差異無統(tǒng)計學(xué)意義(P0.05)。AKS膝關(guān)節(jié)評分比較,術(shù)后3月優(yōu)良率CPM組為88.5%,對照組為63.0%,CPM組優(yōu)于對照組(P0.05);術(shù)后6個月優(yōu)良率CPM組為96.15%,對照組為96.29%,組間比較差異無統(tǒng)計學(xué)意義(P0.05)。術(shù)后1、2周,CPM組VAS疼痛評分優(yōu)于對照組(P0.05)。術(shù)后1、2周,兩組患者各自患、健兩側(cè)小腿周徑的差值比較,CPM組優(yōu)于對照組(P0.05)。結(jié)論:膝關(guān)節(jié)周圍骨折術(shù)后早期應(yīng)用CPM機(jī),加快恢復(fù)膝關(guān)節(jié)活動度,促進(jìn)腫脹消退,緩解患者疼痛,提高患者主動鍛煉的積極性,對膝關(guān)節(jié)功能更好、更快恢復(fù)有重要的臨床意義。
[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 鹵12.58 years. CPM machine function exercise was performed on the second day after operation, 2 hours per day. The initial angle was 30 擄, and gradually increased to 90 擄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 鹵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.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 張英澤;馮和林;李增炎;;膝關(guān)節(jié)周圍骨折術(shù)后綜合康復(fù)訓(xùn)練的臨床療效[J];中國康復(fù)醫(yī)學(xué)雜志;2006年02期

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本文編號：1882613