Jaspers Theo, Taeymans Jan, Hirschmüller Anja, Baur Heiner, Hilfiker Roger, Rogan Slavko
Therapien, Siloam Klinik, Bern, Switzerland.
Departement Gesundheit, Berner Fachhochschule, Bern, Switzerland.
Z Orthop Unfall. 2019 Jun;157(3):279-291. doi: 10.1055/a-0710-5127. Epub 2018 Oct 15.
This systematic review and meta-analysis evaluates the results of empirical studies on the effects of CPM on rehabilitation after ACL reconstruction. The research question was: what are the effects of CPM on ROM, swelling and pain after ACL reconstruction?
PATIENTS/MATERIAL AND METHODS: We searched in MEDLINE, Embase, CINAHL, Cochrane and PEDro up to January 2018. Standardized mean differences (SMD) were expressed as Hedges' g, in order to correct for overestimation of the true effect in small study samples. The 95% confidence intervals (95% CI) were calculated for both the individual studies and the overall weighted estimate. Outcomes were range of motion, pain and swelling.
Eight studies comprising 442 participants were included in the meta-analysis. Beneficial effects of CPM could be identified for the need for pain medication (Hedges' g = 0.93; 95% CI = 0.41 to 1.45 during the first 24 hours after surgery), the number of PCA button pushes by the patient during the first 24 hours after surgery (MD = 31.20; 95% CI = 11.35 to 51.05), on regaining knee flexion on the third to the seventh postoperative day (MD = 11.6°; 95% CI = 1.96 to 21.33) as well as in the third to the sixth postoperative week (Hedges' g = 0.93; 95% CI = 0.41 to 1.44) and on swelling of the knee in the fourth to sixth postoperative week (Hedges' g = 0.77; 95% CI = 0.35 to 1.18).
This meta-analysis suggests that CPM has beneficial effects on pain reduction during the first two postoperative days, on knee flexion during the first to the sixth postoperative weeks and on swelling between the fourth and the sixth postoperative weeks. However, the risk-of-bias scores do not allow a high level of evidence.
本系统评价和荟萃分析评估了关于持续被动运动（CPM）对前交叉韧带重建术后康复效果的实证研究结果。研究问题为：CPM对前交叉韧带重建术后的关节活动度、肿胀和疼痛有何影响？
患者/材料与方法：我们检索了截至2018年1月的MEDLINE、Embase、CINAHL、Cochrane和PEDro数据库。标准化均数差（SMD）以Hedges' g表示，以校正小样本研究中对真实效应的高估。计算了各独立研究以及总体加权估计的95%置信区间（95%CI）。结局指标为关节活动度、疼痛和肿胀。
荟萃分析纳入了八项研究，共442名参与者。可确定CPM对术后24小时内的止痛需求（Hedges' g = 0.93；95%CI = 0.41至1.45）、术后24小时内患者按压自控镇痛（PCA）按钮的次数（MD = 31.20；95%CI = 11.35至51.05）、术后第3至7天恢复膝关节屈曲（MD = 11.6°；95%CI = 1.96至21.33）以及术后第3至6周（Hedges' g = 0.93；95%CI = 0.41至1.44）和术后第4至6周膝关节肿胀（Hedges' g = 0.77；95%CI = 0.35至1.18）均有有益影响。
本荟萃分析表明，CPM对术后前两天的疼痛减轻、术后第一至六周的膝关节屈曲以及术后第四至六周的肿胀有有益影响。然而，偏倚风险评分不支持高水平证据。
