血友病性关节炎行全膝置换术患者康复治疗的效果
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摘要
目的探讨康复治疗在行全膝关节置换术血友病性关节炎患者中的应用效果。方法选取血友病性膝关节炎患者10例(14例膝),均行全膝关节置换术。根据患者情况制定术前及术后康复治疗计划,并分别于术前及术后1、3、6个月通过测量关节活动度、膝关节HSS功能评分对患者关节功能恢复情况进行评价。结果 10例患者康复治疗后伸膝角度、膝关节HSS功能评分均较术前明显改善(P<0.05),屈膝角度与术前比较差异无统计学意义(P>0.05)。所有患者术后均未出现关节内出血、切口感染、假体松动及下肢深静脉血栓等不良并发症,且术后3个月膝关节功能均达优良标准(HSS评分>80分)。结论在控制患者出血风险的前提下,对行全膝关节置换术血友病性关节炎患者进行康复治疗安全可行,能够帮助患者恢复关节活动度及患肢功能。
Objective To explore the efficacy of rehabilitation therapy in patients with hemophilic arthritis after total knee arthroplasty.Methods Ten patients(14 knees) underwent total knee arthroplasty for hemophilic arthritis.Preoperative and postoperative rehabilitation plans were developed according to patient conditions.The joint function was evaluated by measuring motion range and HSS knee function score before and 1,3 and 6 months after operation.Results After rehabilitation therapy,the knee extension angle and HSS score were obviously improved in all patients(P<0.05),while the improvement in flexion angle was not significant(P>0.05).No patients had adverse complications,such as intraarticular bleeding,incision infection,prosthesis loosening and deep venous thrombosis of lower limbs.At 3 months after operation,all patients had excellent knee function(HSS score>80).Conclusion Under the premise of controlling the risk of bleeding,rehabilitation therapy can safely and effectively promote the recovery of joint motion and limb function in patients with hemophilic arthritis after total knee arthroplasty.
Objective To explore the efficacy of rehabilitation therapy in patients with hemophilic arthritis after total knee arthroplasty.Methods Ten patients(14 knees) underwent total knee arthroplasty for hemophilic arthritis.Preoperative and postoperative rehabilitation plans were developed according to patient conditions.The joint function was evaluated by measuring motion range and HSS knee function score before and 1,3 and 6 months after operation.Results After rehabilitation therapy,the knee extension angle and HSS score were obviously improved in all patients(P<0.05),while the improvement in flexion angle was not significant(P>0.05).No patients had adverse complications,such as intraarticular bleeding,incision infection,prosthesis loosening and deep venous thrombosis of lower limbs.At 3 months after operation,all patients had excellent knee function(HSS score>80).Conclusion Under the premise of controlling the risk of bleeding,rehabilitation therapy can safely and effectively promote the recovery of joint motion and limb function in patients with hemophilic arthritis after total knee arthroplasty.
引文
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[11] 李晔,翁习生,林进,等.血友病性骨关节病围手术期伤口并发症处理[J].中华骨与关节外科杂志,2015,8(5):412-416.
[12] HOFFMAN M,MONROE D M.Wound healing in haemophilia-breaking the vicious cycle[J].Haemophilia,2010,16(S3):13-18.
[13] RODRIGUEZ MERCHAN E C,GOMEZ CARDERO P,JIMENEZ YUSTE V.Infection after total knee arthroplasty in haemophilic arthropathy with special emphasis on late infection[J].Haemophilia,2011,17(5):e831-e832.
[14] CHUGHTAI M,ELMALLAH R K,CHERIAN J J,et al.Rehabilitation and pain management modalities in total knee arthroplasty[J].J Knee Surg,2016,29(3):179.
[15] MECHLENBURG I,SKOFFER B,DALGAS U,et al.Comparison of early high-intensity and low-intensity rehabilitation after total knee arthroplasty:comment on the article by bade et al[J].Arthritis Care Res(Hoboken),2018,70(11):1717.
[16] ERNSTBRUNNER L,HINGSAMMER A,CATANZARO S,et al.Long-term results of total knee arthroplasty in haemophilic patients:an 18-year follow-up[J].Knee Surg Sports Traumatol Arthrosc,2017,25(11):3431-3438.
[17] SONG S J,BAE J K,PARK C H,et al.Mid-term outcomes and complications of total knee arthroplasty in haemophilic arthropathy:a review of consecutive 131 knees between 2006 and 2015 in a single institute[J].Haemophilia,2018,24(2):299-306.
[2] BUDA R,CAVALLO M,CASTAGNINI F,et al.Osteochondral repair in hemophilic ankle arthropathy:from current options to future perspectives[J].Joints,2015,3(4):201-207.
[3] 王学锋,冯建民,孙竞,等.中国血友病骨科手术围术期处理专家共识[J].中华骨与关节外科杂志,2016,9(5):361-370.
[4] INSALL J N,DORR L D,SCOTT R D,et al.Rationale of the knee society clinical rating system[J].Clin Orthop Relat Res,1989(248):13-14.
[5] PIPE S W.New therapies for hemophilia[J].Hematology Am Soc Hematol Educ Program,2016,2016:650-656.
[6] LIN W Y,WANG J D,TSAN Y T.Comparison of total joint replacement rate between patients with hemophilia a and patients with hemophilia b:a population-based and retrospective cohort study[J].Clin Appl Thromb Hemost,2018 Sep 13:1076029618794294.[Epub ahead of print]
[7] CUESTA BARRIUSO R,GOMEZ CONESA A,LOPEZ PINA J A.Physiotherapy treatment in patients with hemophilia and chronic ankle arthropathy:a systematic review[J].Rehabil Res Pract,2013,2013:305249.
[8] ZHU W,HE X,XIA Z,et al.Hemophilic arthropathy in a patient with multi-joint replacement:a case report and literature review [J].Medicine(Baltimore),2018,97(29):e11163.
[9] SRIVASTAVA A,BREWER A K,MAUSER BUNSCHOTEN E P,et al.Guidelines for the management of hemophilia[J].Haemophilia,2013,19(1):e1-e47.
[10] PANOVSKI M J,FILDISHEVSKI I V,OGNJENOVIC L L,et al.New surgical technologies could facilitate surgical hemostasis in hemophilic patients[J].Open Access Maced J Med Sci,2017,5(3):295-298.
[11] 李晔,翁习生,林进,等.血友病性骨关节病围手术期伤口并发症处理[J].中华骨与关节外科杂志,2015,8(5):412-416.
[12] HOFFMAN M,MONROE D M.Wound healing in haemophilia-breaking the vicious cycle[J].Haemophilia,2010,16(S3):13-18.
[13] RODRIGUEZ MERCHAN E C,GOMEZ CARDERO P,JIMENEZ YUSTE V.Infection after total knee arthroplasty in haemophilic arthropathy with special emphasis on late infection[J].Haemophilia,2011,17(5):e831-e832.
[14] CHUGHTAI M,ELMALLAH R K,CHERIAN J J,et al.Rehabilitation and pain management modalities in total knee arthroplasty[J].J Knee Surg,2016,29(3):179.
[15] MECHLENBURG I,SKOFFER B,DALGAS U,et al.Comparison of early high-intensity and low-intensity rehabilitation after total knee arthroplasty:comment on the article by bade et al[J].Arthritis Care Res(Hoboken),2018,70(11):1717.
[16] ERNSTBRUNNER L,HINGSAMMER A,CATANZARO S,et al.Long-term results of total knee arthroplasty in haemophilic patients:an 18-year follow-up[J].Knee Surg Sports Traumatol Arthrosc,2017,25(11):3431-3438.
[17] SONG S J,BAE J K,PARK C H,et al.Mid-term outcomes and complications of total knee arthroplasty in haemophilic arthropathy:a review of consecutive 131 knees between 2006 and 2015 in a single institute[J].Haemophilia,2018,24(2):299-306.