连续被动运动和吊带运动训练对全膝关节置换术后临床和功能结果的影响：一项随机主动对照临床研究。

The effect of continuous passive motion and sling exercise training on clinical and functional outcomes following total knee arthroplasty: a randomized active-controlled clinical study.

机构信息

Department of Orthopedics, Doberaner Strasse 142, Rostock 18057, Germany.

出版信息

Health Qual Life Outcomes. 2014 May 9;12:68. doi: 10.1186/1477-7525-12-68.

DOI:10.1186/1477-7525-12-68

PMID:24886619

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4024275/

Abstract

BACKGROUND

The parallel-group randomized active-controlled clinical study was conducted to compare the effectiveness of two in-hospital range of motion (ROM) exercise programs following total knee arthroplasty (TKA). Continuous passive motion (CPM) is frequently used to increase ROM and improve postoperative recovery despite little conclusive scientific evidence. In contrast, a new active sling-based ROM therapy requires the activation of the knee joint muscles and dynamic joint stabilization. It was hypothesized that higher demands on muscle strength and muscle coordination during sling exercise training (ST) might be advantageous for early recovery following TKA.

METHODS

A total of 125 patients undergoing primary TKA were assessed for eligibility. Thirty-eight patients were randomly assigned to receive ST or CPM (control intervention) during hospital stay. Patients were assessed before TKA for baseline measurement (pretest), 1 day before discharge (posttest) and 3 months after TKA (follow-up). The passive knee flexion range of motion (pFL) was the primary outcome measure. Secondary outcome measures included active knee flexion range of motion, active and passive knee extension ROM, static postural control, physical activity, pain, length of hospital stay as well as clinical, functional and quality-of-life outcomes (SF-36, HSS and WOMAC scores). Data were analyzed according to the intention-to-treat principle. Differences between the groups were tested for significance by the unpaired Student's t test or an analysis of covariance (ANCOVA) adjusted for baseline, weight, sex, age, pain and physical activity.

RESULTS

A between-group difference could be determined at posttest. The pFL was significantly higher by 6.0° (95% CI 0.9 to 11.2°; P = 0.022) in the ST group. No difference between groups in pFL was documented at follow-up. Furthermore, no significant differences could be observed for any secondary outcome measure at posttest and follow-up.

CONCLUSIONS

ST seems to have a clinically relevant beneficial short-term effect on pFL compared to CPM. The results support the implementation of ST in rehabilitation programs following TKA.

LEVEL OF EVIDENCE

Therapy, level 2b.

摘要

背景

本平行分组随机对照临床试验旨在比较两种全膝关节置换术后的住院内关节活动度（ROM）锻炼方案的效果。尽管缺乏确凿的科学证据，但持续被动运动（CPM）常被用于增加 ROM 并促进术后恢复。相比之下，一种新的主动吊带式 ROM 治疗需要激活膝关节肌肉并实现动态关节稳定。研究假设，吊带运动训练（ST）对肌肉力量和肌肉协调性的更高要求可能有利于 TKA 术后的早期恢复。

方法

共评估了 125 名接受初次 TKA 的患者是否符合入选条件。38 名患者被随机分配至接受 ST 或 CPM（对照干预）治疗。患者在 TKA 前进行基线测量（术前）、出院前 1 天（术后）和 TKA 后 3 个月（随访）。主要结局测量指标为膝关节被动屈曲 ROM（pFL）。次要结局测量指标包括膝关节主动屈曲 ROM、膝关节主动和被动伸展 ROM、静态姿势控制、体力活动、疼痛、住院时间以及临床、功能和生活质量结局（SF-36、HSS 和 WOMAC 评分）。数据根据意向治疗原则进行分析。通过配对学生 t 检验或调整基线、体重、性别、年龄、疼痛和体力活动的协方差分析（ANCOVA）对组间差异进行显著性检验。