CPM机功能锻炼在膝关节置换术中的应用

Application of CPM Machine Functional Exercise in Knee Replacement

摘要: 目的：明确对于全膝置换术后患者，术后采取持续性被动活动机(continue passive motion, CPM)开展辅助锻炼对术后患者膝关节活动度和患者疼痛程度的影响。方法：收集2016年6月~2018年8月骨科收治重度骨关节炎、膝关节软骨损伤并行单侧全膝关节置换术60例患者，随机分为对照组30例、观察组30例。对照组开展一般康复功能锻炼，观察组除了基础康复外，加用CPM机进行训练。2组病例的术后住院天数及关节活动度(range of motion, ROM)比较。选择疼痛视觉模拟评分法(Visual Analogue Scale/Score, VAS)进行疼痛评分。应用膝关节功能评分(Hospital for Special Surgery Knee Score, HSS)对患者的膝关节术后康复效果进行评价。评估护理满意度。结果：观察组住院天数为10.7 ± 1.2天，对照组住院天数为13.1 ± 2.6天，观察组与对照组相比住院时间明显缩短(P < 0.01)；观察组出院时关节活动度为110.2˚ ± 5.5˚，对照组出院时关节活动度为92.1˚ ± 5.8˚，观察组关节活动度明显优于对照组(P = 0.0005)。观察组术后第1天疼痛VAS评分5.97 ± 0.23分，第2天为4.65 ± 0.29分，第3天为3.11 ± 0.21分，第5天为1.78 ± 0.24分，第7天为0.91 ± 0.23分。对照组术后第1天疼痛评分6.53 ± 0.42分，第2天为5.38 ± 0.34分，第3天为4.79 ± 0.26分，第5天为3.15 ± 0.12分，第7天为1.89 ± 0.34分。观察组术后VAS评分显著低于对照组(术后第1天观察组vs 对照组P = 0.019；术后第2天P = 0.005；术后第3天P = 0.011；术后第5天P = 0.002；术后第7天P = 0.006)。观察组病例康复效果评估等级优为23例，占76.6%，良为4例，占13.3%，中为2例，占6.7%，差为1例，占3.3%。对照组病例康复效果评估等级优为13例，占43.3%，良为8例，占26.7%，中为4例，占13.3%，差为5例，占16.7%。观察组膝关节的康复HSS评分优秀率为76.6%，显著高于对照组的43.3%，差异有统计学意义(P = 0.0013)。观察组病例护理满意度等级非常满意为20例，占66.67%，基本满意为8例，占26.67%，不满意为2例，占6.66%，总满意度为93.34%。观察组病例护理满意度等级非常满意为14例，占46.67%，基本满意为9例，占30%，不满意为7例，占23.33%，总满意度为76.67%。观察组护理满意度93.34%高于对照组的76.67%(P = 0.0009)。结论：CPM是一个较新的治疗概念，但是目前应用上还是探索阶段，应用范围主要还是膝关节置换术后的康复阶段，其应用可以促进膝关节功能恢复，防止关节僵硬，提高膝关节活动度，相信CPM这一临床治疗方法会进一步完善，为关节外科治疗带来巨大进步。

Abstract: Objective: To investigate the effect of continuing passive motion (CPM) on postoperative knee joint motion and pain after total knee replacement. Methods: From June 2016 to August 2018, 60 patients with severe osteoarthritis and cartilage injury of knee joint and unilateral total knee replacement were selected as the study subjects, and randomly divided into a control group of 30 patients and an observation group of 30 patients. The control group received routine early rehabilitation training without CPM machine, while the observation group received routine early rehabilitation training with CPM machine for auxiliary functional exercise. The mean postoperative hospital stay and range of motion (ROM) at discharge were compared. Visual Analogue Scale/ Score (VAS) was used to score pain. The Hospital for Special Surgery Knee Score (HSS) was used to evaluate the postoperative recovery effect of the Knee joint. Evaluate nursing satisfaction. Results: The length of hospitalization was 10.7 ± 1.2 days in the observation group, 13.1 ± 2.6 days in the control group, and the length of hospitalization was significantly shorter in the observation group than in the control group (P < 0.01). The range of motion of the joints in the observation group was 110.2˚ ± 5.5˚ at discharge, and that in the control group was 92.1˚ ± 5.8˚ at discharge. The range of motion of the joints in the observation group was significantly better than that in the control group (P = 0.0005). The VAS scores of the observation group were 5.97 ± 0.23 points on the first day, 4.65 ± 0.29 points on the second day, 3.11 ± 0.21 points on the third day, 1.78 ± 0.24 points on the fifth day, and 0.91 ± 0.23 points on the seventh day. The pain score of the control group was 6.53 ± 0.42 points on day 1, 5.38 ± 0.34 points on day 2, 4.79 ± 0.26 points on day 3, 3.15 ± 0.12 points on day 5, and 1.89 ± 0.34 points on day 7. VAS scores in the observation group were lower than those in the control group on day 1, 2, 3, 5 and 7 after surgery, with statistically significant differences (on the 1st day after surgery t = 2.418, P = 0.019；on the 2nd day P = 0.005; on the 3rd day P = 0.011; on the 5th day P = 0.002；on the 7th day P = 0.006). In the observation group, 23 cases were rated as excellent, accounting for 76.6%; 4 cases as good, accounting for 13.3%; 2 cases as medium, accounting for 6.7%; and 1 case as poor, accounting for 3.3%. The evaluation grade of the rehabilitation effect of the control group was excellent in 13 cases (43.3%), good in 8 cases (26.7%), medium in 4 cases (13.3%), and poor in 5 cases (16.7%). The excellent rate of knee rehabilitation HSS score in the observation group was 76.6%, significantly higher than that in the control group (43.3%) (P = 0.0013). In the observation group, the nursing satisfaction level was very satisfied for 20 cases, accounting for 66.67%, basic satisfaction for 8 cases (26.67%), dissatisfaction for 2 cases (6.66%), and total satisfaction for 93.34%. In the observation group, the nursing satisfaction level was very satisfied for 14 cases (46.67%), basic satisfaction for 9 cases (30%), dissatisfaction for 7 cases (23.33%), and total satisfaction for 76.67%. The nursing satisfaction in the observation group was 93.34% higher than that in the control group (76.67%) (P = 0.0009). Conclusion: CPM is relatively new treatment concept, but is still exploring stage, the main application range and the rehabilitation after knee arthroplasty stage, its application can promote the knee joint function recovery, prevent join stiffness, improve the knee joint mobility, believe that CPM will further improve the clinical treatment, bring joint surgical treatment of giant CPM big step forward.