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

Abstract

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

CLC Number:

R687.4

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.

Figures/Tables 3

Table 1

Table 2

Table 3

References 30

[1]	REAHL G B, MARINOS D, OʼHARA N N, et al. Risk factors for knee stiffness surgery after tibial plateau fracture fixation[J]. J Orthop Trauma, 2018, 32(9): e339-e343.
[2]	IBRAHIM I O, NAZARIAN A, RODRIGUEZ E K. Clinical management of arthrofibrosis: state of the art and therapeutic outlook[J]. JBJS Rev, 2020, 8(7): e1900223.
[3]	BODENDORFER B M, KEELING L E, MICHAELSON E M, et al. Predictors of knee arthrofibrosis and outcomes after arthroscopic lysis of adhesions following ligamentous reconstruction: a retrospective case-control study with over two years' average follow-up[J]. J Knee Surg, 2019, 32: 536-543. doi: 10.1055/s-0038-1655741 pmid: 29852512
[4]	SHETH U, SNIDERMAN J, WHELAN D B. Early surgery of multiligament knee injuries may yield better results than delayed surgery: a systematic review[J]. J ISAKOS, 2019, 4: 26-32.
[5]	VAISH A, VAISHYA R, BHASIN V B. Etiopathology and management of stiff knees: a current concept review[J]. Indian J Orthop, 2020, 55(2): 276-284.
[6]	EGGELING L, KLEPSCH L, AKOTO R, et al. Clinical results after very early, early and late arthroscopic arthrolysis of the knee[J]. Int Orthop, 2022, 46(2): 265-271.
[7]	XING W, SUN L, SUN L, et al. Comparison of minimally invasive arthrolysis vs. conventional arthrolysis for post-traumatic knee stiffness[J]. J Orthop Sci, 2018, 23(1): 112-116. doi: S0949-2658(17)30274-9 pmid: 29100825
[8]	RAJPUT V, REDDY G, IQBAL S, et al. Traumatic knee dislocation: functional outcomes of a single-surgeon case series of 70 cases[J]. Orthop Proc, 2022, 104-B(Supp 1): 30.
[9]	LINDENFELD T N, WOJTVS E M, HUSAIN A. Surgical treatment of arthrofibrosis of the knee[J]. Instruc Course Lectures, 2020, 49: 211-221.
[10]	刘四海, 崔志刚, 韩新祚, 等. 创伤后膝关节僵直三种治疗方式的疗效分析[J]. 中华外科杂志, 2012, 50(9): 814-817.
	LIU S H, CUI Z G, HAN X Z, et al. The therapeutic effect analysis of three kinds of methods for the management of post traumatic knee stiffness[J]. Chin J Surg, 2012, 50(9): 814-817.
[11]	刘克敏, 曲铁兵. 关节创伤后功能康复的再思考:微创康复理念与实践[J]. 中华创伤骨科杂志, 2019, 21(7): 641-644.
	LIU K M, QU T B. Reflections on functional recovery after articular trauma: conception and practice of minimally invasive rehabilitation[J]. Chin J Orthop Trauma, 2019, 21(7): 641-644.
[12]	DENYER S, HOYT A K, SCHNEIDER A M, et al. Knee arthrodesis: an analysis of surgical risk factors and complications using a national database[J]. Arthroplast Today, 2023, 20: 101098.
[13]	邢文钊, 于俊, 张纯朴, 等. 微创膝关节松解术治疗创伤后膝关节僵直[J]. 中华创伤骨科杂志, 2011, 13(10): 994-996.
[14]	XING W, SUN L, SUN L, et al. Comparison of minimally invasive arthrolysis vs. conventional arthrolysis for post-traumatic knee stiffness[J]. J Orthop Sci, 2018, 23(1): 112-116. doi: S0949-2658(17)30274-9 pmid: 29100825
[15]	HEGAZY A M, ELSOUFY M A. Arthroscopic arthrolysis for arthrofibrosis of the knee after total knee replacement[J]. HSS J, 2011, 7(2): 130-133.
[16]	蒋其宏, 胡懿郃, 曾敏, 等. 开放松解术治疗初次人工全膝关节置换术后关节僵硬[J]. 中国修复重建外科杂志, 2019, 33(3): 307-311.
	JIANG Q H, HU Y H, ZENG M, et al. Open arthrolysis for stiff knee after primary total knee arthroplasty[J]. Chin J Repar Reconstruc Surg, 2019, 33(3): 307-311.
[17]	任自刚, 王强, 王增春, 等. 股神经阻滞在膝关节松解术后康复治疗中的作用[J]. 中国康复理论与实践, 2019, 16(12): 1176-1177.
	REN Z G, WANG Q, WANG Z C, et al. Analgesia of femoral nerve block on knee stiffness in rehabilitation training after surgery[J]. Chin J Rehabil Theory Pract, 2010, 16(12): 1176-1177.
[18]	HOIT G, RUBACHA M, CHAHAL J, et al. Is there a disadvantage to early physical therapy after multiligament surgery for knee dislocation? A pilot randomized clinical trial[J]. Clin Orthop Relat Res, 2021, 479(8): 1725-1736.
[19]	KANEDA H, TAKAHIRA N, TSUDA K, et al. Effects of tissue flossing and dynamic stretching on hamstring muscles function[J]. J Sports Sci Med, 2020, 19(4): 681-689.
[20]	ABDELGHAFOUR K M, ELKALYOBY A, H AMER M, et al. Arthroscopic lysis of adhesions for treatment of post-traumatic knee arthrofibrosis: a prospective study[J]. Cureus, 2023, 15(1): e33275.
[21]	YING C, GUO C, WANG Z, et al. A prediction modeling based on the Hospital for Special Surgery (HSS) Knee Score for poor postoperative functional prognosis of elderly patients with patellar fractures[J]. Biomed Res Int, 2021, 2021: 6620504.
[22]	崔志刚, 刘四海, 薛祖军, 等. 膝关节周围不同部位骨折致膝关节僵直特点分析及早期康复疗效[J]. 中国康复理论与实践, 2010, 16(11): 1005-1007.
	CUI Z G, LIU S H, XUE Z F, et al. Characteristics and early rehabilitation of knee stiffness post different fractures[J]. Chin J Rehabil Theory Pract, 2010, 16(11): 1005-1007.
[23]	ROBERTSON M J, ZINGAS N, BENZEL C, et al. Risk factors for failure of manipulation under anesthesia in posttraumatic knee stiffness[J]. Injury, 2023, 54(10): 111004.
[24]	ZHOU H, TRUDEL G, GOUDREAU L, et al. Knee joint stiffness following immobilization and remobilization: a study in the rat model[J]. J Biomech, 2020, 99: 109471.
[25]	KANEGUCHI A, OZAWA J, MINAMIMOTO K, et al. Morphological and biomechanical adaptations of skeletal muscle in the recovery phase after immobilization in a rat[J]. Clin Biomech (Bristol, Avon), 2020, 75: 104992.
[26]	WANG F, ZHANG Q B, ZHOU Y, et al. The mechanisms and treatments of muscular pathological changes in immobilization-induced joint contracture: a literature review[J]. Chin J Traumatol, 2019, 22(2): 93-98. doi: S1008-1275(18)30296-7 pmid: 30928194
[27]	LARA Y, AGUILERA-SÁEZ J, TOMÁS-HERNÁNDEZ J, et al. Treatment of a post-traumatic stiff knee after an open extensor apparatus injury by arthroscopic arthrolysis through a free flap[J]. Trauma Case Rep, 2021, 36: 100553.
[28]	JESSICA H, ROBERT W, SHANE C, et al. Factors associated with knee stiffness following surgical management of multiligament knee injuries[J]. J Knee Surg, 2017, 30(6): 549-554. doi: 10.1055/s-0036-1593624 pmid: 27788528
[29]	何晴, 李建华, 宋海新. 静态渐进性牵伸技术联合综合康复治疗骨折后膝关节僵硬的疗效观察[J]. 中国康复医学杂志, 2018, 33(11): 1307-1310.
	HE Q, LI J H, SONG H X. Investigation on the effect of static progressive stretch combined with comprehensive rehabilitation for knees stiffness after fracture[J]. Chin J Rehabil Med, 2018, 33(11): 1307-1310.
[30]	MCLAUGHLIN K H, ARCHER K R, SHAFIQ B, et al. Orthopedic surgeons and physical therapists differ regarding rehabilitative needs after lower extremity fracture repair[J]. Physiother Theory Pract, 2023, 39(11): 2446-2453.

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

Factors related to re-falling of knee range of motion after arthrolysis for post-traumatic knee stiffness

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 3

References 30

Related Articles 15

Metrics

Comments

Recommended 0

[1]	WEI Tianyuan, LIN Yufan, HE Yi, SONG Mingjie, LI Chaojinzi, ZHANG Qingsu, DU Xiaoxia. Effect of computer-assisted training on post-stroke dysarthria [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(5): 520-525.
[2]	WEI Ning, ZENG Yanling, JIANG Na, ZHANG Qian, YI Xiaozhe, WANG Jianyun, WANG Dengting, ZHANG Yan, PEI Hongbo, HUANG Chaorong. Impact of parental efficacy in doctor-patient communication on rehabilitation outcomes for children with autism spectrum disorder [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(5): 577-585.
[3]	YANG Yaru, YANG Jian, QIU Fubing, SONG Beibei, WANG Shaopu, XIAO Xiaofei, PENG Yifeng. Health benefits of home-based exercise rehabilitation for people with severe disabilities in Shenzhen, China [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(5): 586-590.
[4]	TANG Letian, LIU Yushu, YANG Yaru, CUI Liangbo, XIAO Xiaofei. Construction of undergraduate curriculum courses of assistive technology using World Health Organization Rehabilitation Competency Framework [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(5): 591-597.
[5]	HUANG Songhua, LING Junqi, GAO Tianhao, HUANG Yijia, BAI Yulong. Effect of wrist-hand orthosis combined with modified constraint-induced movement therapy on upper limb and hand function in patients with stroke [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(5): 606-612.
[6]	ZHANG Qing, LI Yanqun, JIA Wenrong, LIU Qiaoyun, JIANG Ruilin. Research on framework, core content and priority areas of international policy of healthcare, rehabilitation and education services for children with hearing and speech impairments [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 373-380.
[7]	LENG Qing, ZHANG Ying, ZHANG Weifeng. Survey on competency status of hearing and speech rehabilitation professionals in Jiangsu, China [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 389-396.
[8]	JIANG Na, WEI Ning, ZENG Yanling, ZHANG Qian, YI Xiaozhe, CHEN Wanqiang, JING Yuzhen, JI Jing, GUO Xusheng, PEI Hongbo, WANG Jianyun. Influencial factors of average hospitalization costs of rehabilitation inpatients based on quantile regression model [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 397-403.
[9]	YANG Rong, WANG Qian, ZI Yang, CHEN Yiting, LI Yingcai, LENG Jun. Brain-computer interface technology used in rehabilitation medicine in the last decade: a visualized analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 416-423.
[10]	ZHENG Jianling, LIU Huilin, ZHU Lin, GU Bin, YAN Ruxiu, ZHAO Qi, SONG Luping. Effect of early intelligent assisted walking under suspension protection on motor and walking function for stroke patients [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 431-436.
[11]	ZHANG Zhiliang, CHU Hongling, LIU Xiaoxie, ZHOU Mouwang, ZHOU Feifei. Application of early intensive rehabilitation in enhanced recovery after surgery protocol after laminoplasty: a mixed methods research [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 468-478.
[12]	HUANG Longxian, ZUO Yan, CHEN Limei, GU Sijia, JIANG Jinmei, ZHANG Zhiwei. Aspiration after dysphasia in recent twenty years: a visualized analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 292-302.
[13]	LIU Huan, HAN Xue, SONG Jianing, LOU Xiaole, XU Lei. Effect of robotic training under position limitation on upper limbs in patients with shoulder subluxation after stroke [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 303-309.
[14]	ZHU Lan, GUO Chuan, HUANG Sisi, JI Panpan, CHENG Yihui, SHEN Ying. Application of seminar in addition to case-based learning in physical therapy practical teaching [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 368-372.
[15]	LIU Jingyu, YANG Yanyan, ZHANG Yuanmingfei, LIU Xiaoxie, ZHANG Na, ZHANG Zhiliang, ZHOU Mouwang. 2022 Country Report on Medical Rehabilitation Services, Quality and Safety in Health Care System [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(2): 125-140.