Mollinger L A, Steffen T M
Shared Therapeutic Services, Milwaukee, WI 53225.
Phys Ther. 1993 Jul;73(7):437-44; discussion 444-6. doi: 10.1093/ptj/73.7.437.
The purpose of this study was to document the prevalence, severity, and progression of knee flexion contractures (KFCs) in a population of institutionalized elderly and to identify relationships between knee extension and other variables.
The subjects were 112 nursing home residents who exhibited a broad range of ambulation and cognitive function abilities.
Data were collected initially (T1) and after a 10-month period (T2).
Only 25% of the population had extension in the 0- to 5-degree (lacking full extension) range bilaterally at T1 and T2, leaving the majority of subjects with some degree of unilateral KFC. Most of the subjects with a KFC greater than 20 degrees were nonambulatory and had a significantly higher occurrence of resistance to motion than did nonambulators with a KFC of less than 20 degrees. Knee extension measurements did not change in most subjects between T1 and T2. The knees that did show a change in KFC (either an increase or a decrease) had a significantly higher occurrence of resistance to passive motion than did other knees. Compared with the subjects who gained extension, the subjects who lost extension over the study period more frequently had minimal KFC at T1, were ambulatory at T1, showed a regression in ambulation at T2, and developed resistance to motion at T2.
The data confirmed significant positive correlations between degree of KFC and presence of resistance to passive knee motion, cognitive impairment, impaired ambulation, and presence of knee pain. Physical therapy assessment and intervention may be appropriate in nonambulatory nursing home residents with resistance to passive motion, residents with KFC approaching 20 degrees, and ambulatory residents with minimal KFC who develop resistance and begin to regress in ambulation. Several areas for future study are suggested.
本研究旨在记录机构养老老年人中膝关节屈曲挛缩（KFC）的患病率、严重程度及进展情况，并确定膝关节伸展与其他变量之间的关系。
研究对象为112名养老院居民，他们具有广泛的行走和认知功能能力。
在初始阶段（T1）和10个月后（T2）收集数据。
在T1和T2时，仅25%的人群双侧膝关节伸展范围在0至5度（缺乏完全伸展），这使得大多数受试者存在一定程度的单侧KFC。大多数KFC大于20度的受试者不能行走，与KFC小于20度的非行走者相比，其运动阻力的发生率显著更高。在大多数受试者中，T1和T2之间膝关节伸展测量值没有变化。KFC有变化（增加或减少）的膝关节比其他膝关节的被动运动阻力发生率显著更高。与伸展增加的受试者相比，在研究期间伸展减少的受试者在T1时KFC通常较小，在T1时能够行走，在T2时行走能力出现退步，并且在T2时出现运动阻力。
数据证实KFC程度与膝关节被动运动阻力、认知障碍、行走能力受损及膝关节疼痛之间存在显著正相关。对于存在被动运动阻力的非行走养老院居民、KFC接近20度的居民以及KFC较小但出现运动阻力并开始在行走能力上退步的行走居民，物理治疗评估和干预可能是合适的。同时提出了几个未来研究的方向。
