运动康复安全评定在胫骨平台骨折中的临床应用
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摘要
目的:
研究胫骨平台骨折术后通过骨科运动康复安全评定表制定个性化康复运动处方的疗效与安全性。
方法:
随访2003年1月～2007年12月胫骨平台骨折185例采取手术治疗的患者。其中对照组81例,术后采取固定,传统康复等常规治疗;康复组80例,根据骨科运动康复安全评定表制定个性化康复运动处方进行康复治疗。对其进行随访问卷调查,X线检查,并采用HSS膝关节功能评估系统分别评估术后6个月及12个月的膝关节功能。
结果:
术后随访时间6个月,12个月。
①按照HSS评分,康复组膝关节功能优良率术后6、12个月分别是93.8%和81.5% ,均显著高于对照组73.8%和66.2%(P ②康复组术后6个月和12个月并发症发生率分别为9.9%,14.8%,对照组术后6个月和12个月并发症发生率分别为16.1%,35.2%。
③两组患者术后12个月内固定失败情况比较,康复组失败率为12.3%,对照组失败率为16.2%。
结论:
1、采用个性化运动康复处方对改善膝关节功能是有效的。
2、根据骨折类型、固定程度、软组织情况三因素评分指导术后康复训练是安全的。
3、骨折运动疗法安全性评定表为早期安全的运动康复治疗提供了参考依据,能有效地改善骨折患者的预后疗效,适合临床骨科的广泛应用。
Purpose:research tibial fractures postoperative rehabilitation through orthopaedic movement in formulating the safety assessment table personalized efficacy of rehabilitation exercise prescription;
Methods:Made a follow-up visit in the January, 2003 ~2007 year in December shinbone platform bone fracture 185 examples to adopt the patient who the surgery treated. And control group 81 examples, after the technique, adopts fixedly, conventional treatments and so on traditional recovery; The recovery group 80 examples, evaluate the table formulation personalization recovery exercise prescription according to orthopedics movement recovery to carry on the recovery treatment safely. Carries on the revisit questionnaire survey to it, X inspection, and uses the HSS knee joint function appraisal system to appraise the technique latter 6 months and 12 month-long knee joint function separately.
Results:We were followed up for 1 year.
1 in accordance with the HSS score, excellent rate of knee rehabilitation group after 6.12 months were 93.8% and 81.5%, were significantly higher than 73.8% and 66.2% (P 2 rehabilitation group after 6 months and 12 months, complications were 9.9%, 14.8% in the control group after 6 months and 12 months, the incidence of complications was 16.1%, 35.2%.
3 In two group of patient technique latter 12 months the fixed defeat situation comparison, the recovery group failure rate is 12.3%, the control group failure rate is 16.2%.
Conclusion:
1.using individualized exercise prescription to improve knee function recovery is effective.
2.according to fracture type, fixed level, the three factors of soft tissue condition score guide postoperative rehabilitation training is safe.
3.fracture physical therapy safety assessment form for the safe movement of the early to provide a reference for rehabilitation, can improve the prognosis of patients with fracture efficacy for a wide range of orthopedics applications.
研究胫骨平台骨折术后通过骨科运动康复安全评定表制定个性化康复运动处方的疗效与安全性。
方法:
随访2003年1月～2007年12月胫骨平台骨折185例采取手术治疗的患者。其中对照组81例,术后采取固定,传统康复等常规治疗;康复组80例,根据骨科运动康复安全评定表制定个性化康复运动处方进行康复治疗。对其进行随访问卷调查,X线检查,并采用HSS膝关节功能评估系统分别评估术后6个月及12个月的膝关节功能。
结果:
术后随访时间6个月,12个月。
①按照HSS评分,康复组膝关节功能优良率术后6、12个月分别是93.8%和81.5% ,均显著高于对照组73.8%和66.2%(P
③两组患者术后12个月内固定失败情况比较,康复组失败率为12.3%,对照组失败率为16.2%。
结论:
1、采用个性化运动康复处方对改善膝关节功能是有效的。
2、根据骨折类型、固定程度、软组织情况三因素评分指导术后康复训练是安全的。
3、骨折运动疗法安全性评定表为早期安全的运动康复治疗提供了参考依据,能有效地改善骨折患者的预后疗效,适合临床骨科的广泛应用。
Purpose:research tibial fractures postoperative rehabilitation through orthopaedic movement in formulating the safety assessment table personalized efficacy of rehabilitation exercise prescription;
Methods:Made a follow-up visit in the January, 2003 ~2007 year in December shinbone platform bone fracture 185 examples to adopt the patient who the surgery treated. And control group 81 examples, after the technique, adopts fixedly, conventional treatments and so on traditional recovery; The recovery group 80 examples, evaluate the table formulation personalization recovery exercise prescription according to orthopedics movement recovery to carry on the recovery treatment safely. Carries on the revisit questionnaire survey to it, X inspection, and uses the HSS knee joint function appraisal system to appraise the technique latter 6 months and 12 month-long knee joint function separately.
Results:We were followed up for 1 year.
1 in accordance with the HSS score, excellent rate of knee rehabilitation group after 6.12 months were 93.8% and 81.5%, were significantly higher than 73.8% and 66.2% (P
3 In two group of patient technique latter 12 months the fixed defeat situation comparison, the recovery group failure rate is 12.3%, the control group failure rate is 16.2%.
Conclusion:
1.using individualized exercise prescription to improve knee function recovery is effective.
2.according to fracture type, fixed level, the three factors of soft tissue condition score guide postoperative rehabilitation training is safe.
3.fracture physical therapy safety assessment form for the safe movement of the early to provide a reference for rehabilitation, can improve the prognosis of patients with fracture efficacy for a wide range of orthopedics applications.
引文
[1]戴闽.实用骨科治疗与康复[M].北京.人民卫生出版社, 2007.38-46.
[2]戴闽.骨科运动康复[M].北京.人民卫生出版社, 2008.11-46.
[3]王亦璁.骨与关节损伤[M].北京.人民卫生出版社, 2007.116-117.
[4] Marti RK, Kerkhoffs GM, Rademakers MV. Correction of lateral tibial plateau depression and valgus malunion of the proximal tibia. Oper Orthop Traumatol 2007;19:101-13.
[5] Higgins TF, Klatt J, Bachus KN. Biomechanical analysis of bicondylar tibial plateau fixation: how does lateral locking plate fixation compare to dual plate fixation? J Orthop Trauma 2007;21:301-6.
[6] No authors listed. Canadian Orthopaedic Trauma Society: open reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau fractures: results of a multicenter, prospective, randomized clinical trial. J Bone Joint Surg [Am] 2006;88-A: 2613-23.
[7]陈晟,戴闽影响肱骨远端骨折治疗效果的多因素回归分析[J].(中国矫形外科杂志)。1005- 8478(2009)08-0633-03
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[2] Buckwalter JA, Saltzman C, Brown T. The impact of osteoarthritis: implications for research. Clin Orthop 2004;427(suppl):6–15.
[3] Morrey BF, Adams RA, Kessler M. A conservative femoral replacement for total hip arthroplasty: a prospective study. J Bone Joint Surg Br 2000;82: 952–8.
[4] D’Ambrosia RD. Epidemiology of osteoarthritis. Orthopedics 2005;28(suppl 2):201–5.
[5] Hunter DJ, Felson DT. Clinical review: osteoarthritis. BMJ 2006;332:639– 42.
[6] Morrey BF, Adams RA, Kessler M. A conservative femoral replacement for total hip arthroplasty: a prospective study. J Bone Joint Surg Br 2000;82:952–8.
[7] Shimmin A, Beaule PE, Campbell P. Metal-on-metal hip resurfacing arthroplasty. J Bone Joint Surg Am. Mar 2008;90(3):637-54.。
[8] Mancuso CA, Salvati EA, Johanson NA, Peterson MGE, Charlson ME. Patients. expectations and satisfaction with total hip arthroplasty. J Arthroplasty 1997; 12: 387-96.
[9] Britton AR, Murray DW, Bulstrode CJ, McPherson K, Denham RA. Pain levels after total hip replacement: their use as endpoints for survival analysis. J Bone Joint Surg Br 1997; 79: 93-8.
[10] John R. Parziale, MD, Casey J. O’Donnell, DO,David N. Sandman, MD。Iliopsoas BursitisAmerican Journal of Physical Medicine & RehabilitationAm. J. Phys. Med. Rehabil.●Vol. 88, No. 8, August 2009。
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[13] Herald J, Macdessi S, Kirsh G. An unusual cause of groin pain following hip replacement. A case report. J Bone Joint Surg Am. 2001;83:1392-5.
[14] Jasani V, Richards P, Wynn-Jones C. Pain related to the psoas muscle after total hip replacement. J Bone Joint Surg Br. 2002;84:991-3.
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[16] Ling ZX, Kumar VP: The course of the inferior gluteal nerve in the posterior approach to the hip.J Bone Joint Surg Br 2006;88:1580–3
[17] Farrell CM, Springer BD, Haidukewych GJ, et al: Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg 2005;87:2619–25
[18] Bal BS, Haltom D, Aleto T, et al: Early complications of primary total hip replacement performed with a two-incision minimally invasive technique. J Bone Joint Surg 2006; 88:221–3
[19] Taylor CA, Braza D, Rice JB, et al: The incidence of peripheral nerve injury in extremity trauma. Am J Phys Med Rehabil 2008;87:381–512.
[20] Webster D, Murray D. Complications Upadhyay A, York S, Macaulay W, et al: Medical malpractice in hip and knee arthroplasty. J Arthroplasty 2007;22(Suppl 2):2–7
[21] Baker AS, Bitounis VC. Abductor function after total hip replacement: an electromyographic and clinical review. J Bone Joint Surg Br 1989;71B: 47-50.
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[26] Norton BJ, Sahmann SA, Van Dillen FL. Differences in measurements of lumbar curvature related to gender and low back pain. J Orthop Sports Phys Ther 2004;34: 524–34.
[27] Evcik D, Yucel A. Lumbar lordosis in acute and chronic low back pain patients. Rheumatol Int 2003;23:163–5.
[28] Rajnics P. The importance of spinopelvic parameters in patients with lumbar disc lesions. Int Orthop 2002;26:104–8.
[29] Matsuyama Y, Hasegawa Y, Yoshihara H, et al. Hip-spine syndrome: total sagittal alignment of the spine and clinical symptoms in patients with bilateral congenital hip dislocation. Spine 2004;29:2432–7.
[30] Yoshimoto H, Sato S, Masuda T, et al. Spinopelvic alignment in patients with osteoarthrosis of the hip: a radiographic comparison to patients with low back pain. Spine 2005;30:1650–7.
[31] Lavigne M, Rama KR, Roy A, Vendittoli PA. Painful impingement of the hip joint after total hip resurfacing: a report of two cases. J Arthroplasty. 2008 Oct;23(7):1074-9; Epub 2008 Jan
[32] Beaule PE, Harvey N, Zaragoza E, et al. The femoral head/ neck offset and hip resurfacing. J Bone Joint Surg Br. Jan 2007;89(1):9-15.
[33] Fish DE, Chang WS. Treatment of iliopsoas tendinitis after a left total hip arthroplasty with botulinum toxin type A. Pain Physician. Jul 2007;10(4):565-71.
[34] Kim PR, Beaule PE, Laflamme GY, Dunbar M. Causes of early failure in a multicenter clinical trial of hip resurfacing. J Arthroplasty. Sep 2008;23(6 Suppl 1):44-9.
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[36] Herberts P, Malchau H. Long-term registration has improved the quality of hip replacement: a review of the Swedish THR Register comparing 160 000 cases. Acta Orthop Scand 2000; 71: 111-21.
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[2]戴闽.骨科运动康复[M].北京.人民卫生出版社, 2008.11-46.
[3]王亦璁.骨与关节损伤[M].北京.人民卫生出版社, 2007.116-117.
[4] Marti RK, Kerkhoffs GM, Rademakers MV. Correction of lateral tibial plateau depression and valgus malunion of the proximal tibia. Oper Orthop Traumatol 2007;19:101-13.
[5] Higgins TF, Klatt J, Bachus KN. Biomechanical analysis of bicondylar tibial plateau fixation: how does lateral locking plate fixation compare to dual plate fixation? J Orthop Trauma 2007;21:301-6.
[6] No authors listed. Canadian Orthopaedic Trauma Society: open reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau fractures: results of a multicenter, prospective, randomized clinical trial. J Bone Joint Surg [Am] 2006;88-A: 2613-23.
[7]陈晟,戴闽影响肱骨远端骨折治疗效果的多因素回归分析[J].(中国矫形外科杂志)。1005- 8478(2009)08-0633-03
[1] Kim S. Changes in surgical loads and economic burden of hip and knee replacements in the US: 1997e2004. Arthritis Rheum 2008 Apr 15; 59: 481e8.
[2] Buckwalter JA, Saltzman C, Brown T. The impact of osteoarthritis: implications for research. Clin Orthop 2004;427(suppl):6–15.
[3] Morrey BF, Adams RA, Kessler M. A conservative femoral replacement for total hip arthroplasty: a prospective study. J Bone Joint Surg Br 2000;82: 952–8.
[4] D’Ambrosia RD. Epidemiology of osteoarthritis. Orthopedics 2005;28(suppl 2):201–5.
[5] Hunter DJ, Felson DT. Clinical review: osteoarthritis. BMJ 2006;332:639– 42.
[6] Morrey BF, Adams RA, Kessler M. A conservative femoral replacement for total hip arthroplasty: a prospective study. J Bone Joint Surg Br 2000;82:952–8.
[7] Shimmin A, Beaule PE, Campbell P. Metal-on-metal hip resurfacing arthroplasty. J Bone Joint Surg Am. Mar 2008;90(3):637-54.。
[8] Mancuso CA, Salvati EA, Johanson NA, Peterson MGE, Charlson ME. Patients. expectations and satisfaction with total hip arthroplasty. J Arthroplasty 1997; 12: 387-96.
[9] Britton AR, Murray DW, Bulstrode CJ, McPherson K, Denham RA. Pain levels after total hip replacement: their use as endpoints for survival analysis. J Bone Joint Surg Br 1997; 79: 93-8.
[10] John R. Parziale, MD, Casey J. O’Donnell, DO,David N. Sandman, MD。Iliopsoas BursitisAmerican Journal of Physical Medicine & RehabilitationAm. J. Phys. Med. Rehabil.●Vol. 88, No. 8, August 2009。
[11] Adler RS, Buly R, Ambrose R, et al: Diagnostic and therapeutic use of sonography-guided iliopsoas peritendinous injections. AJR 2005;185:940–3
[12] Pritchett JW. Fracture of the greater trochanter after hip replacement. Clin Orthop Relat Res. 2001;390:221-6.
[13] Herald J, Macdessi S, Kirsh G. An unusual cause of groin pain following hip replacement. A case report. J Bone Joint Surg Am. 2001;83:1392-5.
[14] Jasani V, Richards P, Wynn-Jones C. Pain related to the psoas muscle after total hip replacement. J Bone Joint Surg Br. 2002;84:991-3.
[15] Ankarath S, Campbell P. Psoas hematoma presenting as hip pain. Orthopedics. 2001; 24:689-90.
[16] Ling ZX, Kumar VP: The course of the inferior gluteal nerve in the posterior approach to the hip.J Bone Joint Surg Br 2006;88:1580–3
[17] Farrell CM, Springer BD, Haidukewych GJ, et al: Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg 2005;87:2619–25
[18] Bal BS, Haltom D, Aleto T, et al: Early complications of primary total hip replacement performed with a two-incision minimally invasive technique. J Bone Joint Surg 2006; 88:221–3
[19] Taylor CA, Braza D, Rice JB, et al: The incidence of peripheral nerve injury in extremity trauma. Am J Phys Med Rehabil 2008;87:381–512.
[20] Webster D, Murray D. Complications Upadhyay A, York S, Macaulay W, et al: Medical malpractice in hip and knee arthroplasty. J Arthroplasty 2007;22(Suppl 2):2–7
[21] Baker AS, Bitounis VC. Abductor function after total hip replacement: an electromyographic and clinical review. J Bone Joint Surg Br 1989;71B: 47-50.
[22] Cuckler JM, Star AM, Alavi A, Noto RB. Diagnosis and management of the infected total joint arthroplasty. Orthop Clin North Am 1991; 22:523-30.
[23] Robbins GM, Masra BA, Garbuz DS, et al. Evaluation of pain in patients with apparently solidly fixed total hip arthroplasty components. J Am Acad Orthop Surg. 2002;10:86–94.
[24] White RE Jr. Evaluation of the painful total hip arthroplasty. In: Callaghan JJ, Rosenberg AG,Rubash HE, editors. The adult hip. Philadelphia: Lippincott- Raven; 1998. p 1377-85.
[25] Bozic KJ, Rubash HE. The painful total hip replacement. Clin Orthop Relat Res. 2004;420:18-25.
[26] Norton BJ, Sahmann SA, Van Dillen FL. Differences in measurements of lumbar curvature related to gender and low back pain. J Orthop Sports Phys Ther 2004;34: 524–34.
[27] Evcik D, Yucel A. Lumbar lordosis in acute and chronic low back pain patients. Rheumatol Int 2003;23:163–5.
[28] Rajnics P. The importance of spinopelvic parameters in patients with lumbar disc lesions. Int Orthop 2002;26:104–8.
[29] Matsuyama Y, Hasegawa Y, Yoshihara H, et al. Hip-spine syndrome: total sagittal alignment of the spine and clinical symptoms in patients with bilateral congenital hip dislocation. Spine 2004;29:2432–7.
[30] Yoshimoto H, Sato S, Masuda T, et al. Spinopelvic alignment in patients with osteoarthrosis of the hip: a radiographic comparison to patients with low back pain. Spine 2005;30:1650–7.
[31] Lavigne M, Rama KR, Roy A, Vendittoli PA. Painful impingement of the hip joint after total hip resurfacing: a report of two cases. J Arthroplasty. 2008 Oct;23(7):1074-9; Epub 2008 Jan
[32] Beaule PE, Harvey N, Zaragoza E, et al. The femoral head/ neck offset and hip resurfacing. J Bone Joint Surg Br. Jan 2007;89(1):9-15.
[33] Fish DE, Chang WS. Treatment of iliopsoas tendinitis after a left total hip arthroplasty with botulinum toxin type A. Pain Physician. Jul 2007;10(4):565-71.
[34] Kim PR, Beaule PE, Laflamme GY, Dunbar M. Causes of early failure in a multicenter clinical trial of hip resurfacing. J Arthroplasty. Sep 2008;23(6 Suppl 1):44-9.
[35] Amstutz HC, Beaule PE, Dorey FJ, et al. Metal-on-metal Component malalignment with an acetabular cup inserted in almost neutral version. Note anterior angulation of the femoral implant and large anterior femoral neck osteophyte. hybrid surface arthroplasty: two to six-year follow-up study. J Bone Joint Surg Am. Jan 2004;86(1):28-39.。
[36] Herberts P, Malchau H. Long-term registration has improved the quality of hip replacement: a review of the Swedish THR Register comparing 160 000 cases. Acta Orthop Scand 2000; 71: 111-21.
[37] Sculco TP. The economic impact of infected total joint arthroplasty. Instr Course Lect 1993; 42: 349-51.
[38] Fitzgerald JrRH,NolanDR, IlstrupDM, et al. Deepwoundsepsis following total hip arthroplasty. J Bone Joint Surg Am 1977; 59-A: 847-55.
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