创伤后膝关节松解术后关节活动度反弹现象及其影响因素

doi:10.3969/j.issn.1006-9771.2024.05.010

摘要/Abstract

摘要：

目的分析创伤后膝关节僵硬松解术后关节活动度(ROM)恢复后又暂时下降(反弹)的现象及其影响因素。

方法回顾性分析2016年7月至2019年9月北京博爱医院膝关节僵硬患者64例68膝，行微创膝关节松解术后随访12个月。测量患者术前，术后1周、6周、12周、6个月、12个月的膝关节屈伸ROM，采用特殊外科医院膝关节评分(HSS)进行评定，对反弹进行多元Logistic回归分析。

结果术后患者膝关节屈伸ROM和HSS评分总体上改善；HSS评分呈持续性改善；术后6周时，膝关节屈伸ROM较术后1周下降，涉及44例46膝。手术时病程> 12个月、复杂骨折、既往感染史与ROM反弹相关(OR > 8.058, P < 0.05)。

结论微创膝关节松解术能改善膝关节僵硬患者的膝关节功能，但在康复过程中可能出现ROM反弹。手术不及时、骨折复杂、并发感染是反弹的风险因素。

关键词: 创伤后膝关节僵硬, 关节松解术, 关节活动度, 康复

Abstract:

Objective To observe the temporary loss (re-falling) of knee range of motion (ROM) during rehabilitation after arthrolysis for post-traumatic knee stiffness, and analyze the factors related to it.

Methods From July, 2016 to September, 2019, 64 patients (68 knees) in Beijing Bo'ai Hospital accepted minimally invasive arthrolysis for post-traumatic knee stiffness, and were followed up for twelve months. ROM of flexion and extension of knee was measured before operation, and one, six and twelve weeks, and six and twelve months after operation; while they were asssessed with Hospital for Special Surgery Knee Score (HSS). Multivariate Logistic regression was performed on re-falling.

Results The ROM and HSS score improved as a whole after operation; however, HSS score improved constantly, but ROM decreased six weeks after operation compared with that one weeks after operation, involving 46 knees of 44 cases. Arthrolysis longer than 12 months from primary injuries, multiple complicated fracture and history of infection were the risk factors for re-falling (OR > 8.058, P < 0.05).

Conclusion Minimally invasive arthrolysis is effective on knee function after arthrolysis for post-traumatic knee stiffness. However, re-falling of ROM may happen during rehabilitation. Delay of operation, multiple complicated fracture and history of infection may increase the risk of re-falling.

Key words: post-traumatic knee stiffness, arthrolysis, range of motion, rehabilitation

中图分类号:

R687.4

崔志刚, 晋陶然, 刘四海, 王飞, 刘克敏, 李建军. 创伤后膝关节松解术后关节活动度反弹现象及其影响因素[J]. 《中国康复理论与实践》, 2024, 30(5): 565-569.

CUI Zhigang, JIN Taoran, LIU Sihai, WANG Fei, LIU Kemin, LI Jianjun. Factors related to re-falling of knee range of motion after arthrolysis for post-traumatic knee stiffness[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(5): 565-569.

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时间	n	ROM/°	HSS评分
术前	68	31.73±21.06	40±24
术后1周	68	85.52±52.50^a	47±15^a
术后6周	68	60.10±33.01^a,b	57±26^a
术后12周	68	79.33±44.10^a,c	80±41^a
术后6个月	68	91.80±31.41^a,c	88±33^a
术后12个月	68	94.52±46.90^a,c	93±36^a

变量		n	反弹组 (n = 46)^a	无反弹组 (n = 22)	χ²值	P值	变量		n	反弹组 (n = 46)^a	无反弹组 (n = 22)	χ²值	P值
性别	男	51	36	15	0.806	0.528	术前ROM	< 60°	22	13	9	1.088	0.138
	女	17	10	7				≥ 60°	46	33	13
年龄	< 40岁	49	34	15	0.243	0.414	术前HSS评分	< 70	43	31	12	1.056	0.223
	≥ 40岁	19	12	7				≥ 70	25	15	10
病因	创伤性	40	28	18	2.984	0.071	骨折部位	关节外	46	28	12	0.246	0.406
	非创伤性	28	18	4				关节内或混合性	22	18	10
损伤类型	闭合性	56	35	21	2.624	0.575	既往感染	无	49	29	20	5.740	0.014
	开放性	12	11	1				有	19	17	2
术前ADL	< 60分	20	10	10	4.032	0.106	是否使用	否	50	35	15	0.478	0.348
评分	≥ 60分	48	36	12			外固定	是	18	11	7
骨折数量	单纯骨折	35	18	17	8.668	0.003	术后是否使用	否	24	17	7	0.172	0.537
	复杂骨折	33	28	5			CPM	是	44	29	15
手术时病程	< 12个月	32	14	18	15.722	< 0.001	术后是否使用	否	13	8	5	0.274	0.414
	≥ 12个月	36	32	4			夹板或石膏	是	55	38	17

变量	B	SE	Wald	自由度	P值	OR
病因	1.343	0.778	2.981	1	0.084	3.829
骨折数量	2.087	0.809	6.658	1	0.010	8.058
手术时病程	2.112	0.712	8.797	1	0.003	8.266
既往感染	2.246	0.998	5.062	1	0.024	9.454
常量	-13.413	3.551	14.269	1	0.000