Polat Gökhan, Karademir Gökhan, Akalan Ekin, Aşık Mehmet, Erdil Mehmet
Department of Orthopaedics and Traumatology, Istanbul University, Istanbul Medical Faculty, Çapa-Fatih, Istanbul, 34093, Turkey.
Faculty of Science Health Physiotherapy & Rehab. Division, Istanbul University, Istanbul, Turkey.
J Orthop Surg Res. 2017 Mar 20;12(1):46. doi: 10.1186/s13018-017-0548-5.
The aim of this study was to prospectively evaluate the compliance of our patients with a touchdown weight bearing (without supporting any weight on the affected side by only touching the plantar aspect of the foot to the ground to maintain balance to protect the affected side from mechanical loading) postoperative rehabilitation protocol after treatment of talar osteochondral lesion (TOL).
Fourteen patients, who had been treated with arthroscopic debridement and microfracture, were followed prospectively. The patients were evaluated for weight bearing compliance with using a stationary gait analysis and feedback system at the postoperative first day, first week, third week, and sixth week.
The mean visual analog scale (VAS) scores of the patients at the preoperative, postoperative first day, first week, third week, and sixth weeks were 5.5, 5.9, 3.6, 0.9, and 0.4, respectively. The decrease in VAS scores were statistically significant (p < 0.0001). First postoperative day revealed a mean value of transmitted weight of 4.08% ±0.8 (one non-compliant patient). The mean value was 4.34% ±0.8 at the first postoperative week (two non-compliant patients), 6.95% ±2.3 at the third postoperative week (eight non-compliant patients), and 10.8% ±4.8 at the sixth postoperative week (11 non-compliant patients). In the analysis of data, we found a negative correlation between VAS scores and transmitted weight (Kendall's tau b = -0.445 and p = 0.0228).
Although patients were able to learn and adjust to the touchdown weight bearing gait protocol during the early postoperative period, most patients became non-compliant when their pain was relieved. To prevent this situation of non-compliance, patients should be warned to obey the weight bearing restrictions, and patients should be called for a follow-up at the third postoperative week.
本研究的目的是前瞻性评估距骨骨软骨损伤（TOL）治疗后患者对触地负重（仅通过将足底与地面接触以保持平衡来避免患侧承受任何重量，从而保护患侧免受机械负荷）术后康复方案的依从性。
对14例接受关节镜清创和微骨折治疗的患者进行前瞻性随访。在术后第1天、第1周、第3周和第6周，使用静态步态分析和反馈系统评估患者的负重依从性。
患者术前、术后第1天、第1周、第3周和第6周的平均视觉模拟量表（VAS）评分分别为5.5、5.9、3.6、0.9和0.4。VAS评分的降低具有统计学意义（p < 0.0001）。术后第1天显示平均传递重量值为4.08%±0.8（1例不依从患者）。术后第1周平均重量值为4.34%±(0.8（2例不依从患者），术后第3周为6.95%±2.3（8例不依从患者），术后第6周为10.8%±4.8（11例不依从患者）。在数据分析中，我们发现VAS评分与传递重量之间存在负相关（肯德尔tau b = -0.445，p = 0.0228）。
尽管患者在术后早期能够学习并适应触地负重步态方案，但大多数患者在疼痛缓解后变得不依从。为防止这种不依从情况，应警告患者遵守负重限制，并在术后第3周对患者进行随访。
