Bassett F H, Beck J L, Weiker G
Am J Sports Med. 1980 Mar-Apr;8(2):63-7. doi: 10.1177/036354658000800202.
It has been well-proven that prolonged immobilization is detrimental to synovial joints. For the past 5 years, in an effort to minimize these undesirable sequelae, we have treated 94 patients with major knee trauma by early protected motion. Acute ligament injuries not requiring surgery were placed in the cast brace immediately, while operated cases were started about the 10th postoperative day. Our method of cast bracing stresses proper alignment of the joints, security of limb position, prevention of swelling complications, and economy of physician time. A special feature is a modified single axis joint that restricts the arc of motion to safe limits, generally 30 to 90 degrees. Functionally, our results compare quite favorably with our previous traditionally treated experience. Rehabilitation times were markedly shortened, patient acceptance was high, and complications were rare. Early motion was extremely well-tolerated with only one cast removed because of discomfort. Postoperative effusion rapidly disappeared with commencement of motion. Rapid return of motion did not correlate with a poor result, and the stability of operated knees did not loosen with time. Although lack of controls precludes definitive comparisons, we conclude that early protected motion is safe and provides significant benefits.
长期制动对滑膜关节有害，这一点已得到充分证实。在过去5年里，为尽量减少这些不良后遗症，我们对94例严重膝关节创伤患者采用了早期保护性活动的治疗方法。对于不需要手术的急性韧带损伤患者，立即使用管型支具固定，而接受手术的患者则在术后第10天左右开始进行活动。我们使用管型支具的方法强调关节的正确对线、肢体位置的固定、预防肿胀并发症以及节省医生的时间。一个特别之处是改良的单轴关节，它将活动弧限制在安全范围内，一般为30至90度。从功能上看，我们的结果与我们之前传统治疗的经验相比相当不错。康复时间明显缩短，患者接受度高，并发症罕见。早期活动耐受性极佳，只有一例因不适而拆除支具。随着活动开始，术后积液迅速消失。活动的快速恢复与不良结果无关，手术膝关节的稳定性也不会随时间而松动。虽然缺乏对照无法进行明确比较，但我们得出结论，早期保护性活动是安全的，且能带来显著益处。
