运动学对线技术对全膝关节置换术后关节活动度的效果

doi:10.3969/j.issn.1006-9771.2022.07.004

摘要/Abstract

摘要：

目的探讨运动学对线技术对全膝关节置换患者术后膝关节功能康复的影响。

方法 2020年6月到2021年10月,选择北京朝阳医院初次行全膝关节置换术的患者200例,随机分为传统机械对线组(MA组)和运动学对线组(KA组),各100例。术后均行常规康复。记录患者术前和术后3个月膝关节学会评分(KSS),术前、术后3 d和术后3个月的疼痛视觉模拟评分(VAS),首次下地时间,首次主动直腿抬高30°时间,术前、术后1 d、2 d、3 d、1个月和3个月时患侧膝关节主动屈曲角度,以及出院转归情况。

结果最终MA组96例、KA组98例完成随访。KA组术后膝关节主动屈曲角度大于MA组(F_组别 = 8.816, P = 0.017)。KA组术后需要进行机构康复的比例小于MA组(χ² = 6.542, P = 0.011)。

结论 KA可促进患者术后膝关节运动快速恢复,减少机构康复需求,节约医疗成本。

关键词: 全膝关节置换术, 运动学对线, 康复

Abstract:

Objective To explore the effect of kinematic alignment on postoperative knee function for patients after total knee arthroplasty (TKA).

Methods From June, 2020 to October, 2021, 200 patients undergoing primary TKA in Beijing Chaoyang Hospital were divided into mechanical alignment (MA) group (n = 100) and kinematic alignment (KA) group (n = 100). All the patients accepted comprehensive rehabilitation after operation. They were assessed with Keen Society Score (KSS) before and three months after operation, with Visual Analogue Scale for pain (VAS) before, and three days and three months after operation. The time of first standing, the time of first straight-leg raising more than 30°, and the active range of motion (AROM) of knee before, and one, two and three days, and one and three months after operation were recorded, as well as where to go after discharge.

Results A total of 96 patients in MA group and 98 in KA group finished the research. The AROM of knee improved more in the KA group than in the MA group after operation (F_group = 8.816, P = 0.017), and the incidence going to the rehabilitation institutes was less (χ²= 6.542, P = 0.011).

Conclusion KA may promote the rapid recovery of AROM of knee for patients after TKA, and reduce the needs of institute-based rehabilitation after discharge, to save medical costs.

Key words: total knee arthroplasty, kinematic alignment, rehabilitation

中图分类号:

R687.4

张琦,梁媛,张冉,王志为,季长高. 运动学对线技术对全膝关节置换术后关节活动度的效果[J]. 《中国康复理论与实践》, 2022, 28(7): 764-769.

ZHANG Qi,LIANG Yuan,ZHANG Ran,WANG Zhiwei,JI Changgao. Effects of kinematic alignment on range of motion after total knee arthroplasty[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(7): 764-769.

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项目	MA组(n = 96)	KA组(n = 98)	χ²/t值	P值
性别(男/女)/n	45/51	42/56	0.317	0.574
年龄/岁	65.2±2.6	64.0±1.7	0.154	0.730
侧别(左/右)/n	46/50	50/48	0.187	0.666
身高/cm	160±4.5	161±5.4	1.890	0.365
体质量指数/kg·m^-2	29.9±2.8	28.5±3.5	1.562	0.445
术前VAS(行走)	6.7±2.8	6.4±2.2	0.024	0.876
术前KSS	67.2±7.0	65.8±8.2	0.188	0.702
术前ROM/°	109±5.4	112±7.0	0.775	0.360

组别	n	术后3 d	术后3个月
MA组	96	5.7±2.1	1.7±0.51
KA组	98	5.4±2.8	1.6±0.63
t值		0.632	0.164
P值		0.211	0.787

组别	n	首次下地时间/h	首次直腿抬高> 30°时间/h	出院去向(家庭/机构)/n	术后3个月KSS
MA组	96	32(18)	25(4)	69/27	87.8±3.9
KA组	98	28(14)	23(3)	85/13	89.0±2.8
Z/χ²/t值		-1.699	-1.022	6.542	0.265
P值		0.089	0.228	0.011	0.554

组别	n	术后1 d	术后2 d	术后3 d	术后1个月	术后3个月
MA组	96	62.5±7.2	80.9±9.4	87.2±10.9	107±8.2	109±7.9
KA组	98	80.1±6.7	96.4±5.2	99.0±5.0	109±5.6	110±4.9