全膝关节置换术后长期使用持续被动运动（CPM）作为物理治疗辅助手段的有效性。

Effectiveness of prolonged use of continuous passive motion (CPM), as an adjunct to physiotherapy, after total knee arthroplasty.

作者信息

Lenssen Ton A F, van Steyn Mike J A, Crijns Yvonne H F, Waltjé Eddie M H, Roox George M, Geesink Ruud J T, van den Brandt Piet A, De Bie Rob A

机构信息

University Hospital Maastricht, Department of Physiotherapy, Maastricht, The Netherlands.

出版信息

BMC Musculoskelet Disord. 2008 Apr 29;9:60. doi: 10.1186/1471-2474-9-60.

DOI:10.1186/1471-2474-9-60

PMID:18442423

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2386789/

Abstract

BACKGROUND

Adequate and intensive rehabilitation is an important requirement for successful total knee arthroplasty. Although research suggests that Continuous Passive Motion (CPM) should be implemented in the first rehabilitation phase after surgery, there is substantial debate about the duration of each session and the total period of CPM application. A Cochrane review on this topic concluded that short-term use of CPM leads to greater short-term range of motion. It also suggested, however, that future research should concentrate on the treatment period during which CPM should be administered.

METHODS

In a randomised controlled trial we investigated the effectiveness of prolonged CPM use in the home situation as an adjunct to standardised PT. Efficacy was assessed in terms of faster improvements in range of motion (RoM) and functional recovery, measured at the end of the active treatment period, 17 days after surgery. Sixty patients with knee osteoarthritis undergoing TKA and experiencing early postoperative flexion impairment were randomised over two treatment groups. The experimental group received CPM + PT for 17 consecutive days after surgery, whereas the usual care group received the same treatment during the in-hospital phase (i.e. about four days), followed by PT alone (usual care) in the first two weeks after hospital discharge. From 18 days to three months after surgery, both groups received standardised PT. The primary focus of rehabilitation was functional recovery (e.g. ambulation) and regaining RoM in the knee.

RESULTS

Prolonged use of CPM slightly improved short-term RoM in patients with limited RoM at the time of discharge after total knee arthroplasty when added to a semi-standard PT programme. Assessment at 6 weeks and three months after surgery found no long-term effects of this intervention Neither did we detect functional benefits of the improved RoM at any of the outcome assessments.

CONCLUSION

Although results indicate that prolonged CPM use might have a small short-term effect on RoM, routine use of prolonged CPM in patients with limited RoM at hospital discharge should be reconsidered, since neither long-term effects nor transfer to better functional performance was detected.

TRIAL REGISTRATION

ISRCTN85759656.

摘要

背景

充分且强化的康复治疗是全膝关节置换术成功的一项重要要求。尽管研究表明，术后首个康复阶段应采用持续被动运动（CPM），但关于每次治疗的时长以及CPM应用的总时长仍存在大量争议。一项关于该主题的Cochrane综述得出结论，短期使用CPM可带来更大的短期活动范围。然而，该综述也建议，未来的研究应聚焦于CPM的施用治疗期。

方法

在一项随机对照试验中，我们研究了在家庭环境中延长使用CPM作为标准化物理治疗辅助手段的有效性。在术后17天的积极治疗期结束时，通过活动范围（RoM）和功能恢复的更快改善来评估疗效。60例接受全膝关节置换术且术后早期屈曲功能受损的膝骨关节炎患者被随机分为两个治疗组。实验组在术后连续17天接受CPM + 物理治疗，而常规护理组在住院阶段（约4天）接受相同治疗，出院后头两周仅接受物理治疗（常规护理）。术后18天至3个月，两组均接受标准化物理治疗。康复的主要重点是功能恢复（如行走）和恢复膝关节的RoM。