HSS膝关节康复方案对单髁置换术后早期关节功能和步态的影响.pdf

doi:10.3969/j.issn.1672-5972.2023.04.015文章编号:swgk2022-10-00244生 物 骨 科 材 料 与 临 床 研 究 ORTHOPAEDIC BIOMECHANICS MATERIALS AND CLINICAL STUDY2023 年 08 月第 20 卷 第 4 期HSS膝关节康复方案对单髁置换术后早期关节功能和步态的影响*金军 乔杰 吴斌*钟传棋 霍雄涛摘要 目的 研究美国特种外科医院（hospital for special surgery,HSS）膝关节康复方案对膝关节单髁置换术（unicompartmental knee arthroplasty,UKA）术后关节功能及步态的近期影响。方法 回顾性分析2018年1月至2021年6月间在湖北省中医院行UKA术的60例患者。将采用HSS膝关节成形术康复指南进行康复治疗的30例患者作为HSS组；将同期采用常规康复方案的30例患者作为常规组。记录术后1周、3个月、6个月、1年两组患者的膝关节活动范围（range of motion,ROM）、美国特种外科医院膝关节HSS评分、人工关节遗忘指数（forgotten joint index,FJS）。分别于术后6个月、1年时采用GaitWatch三维步态分析及运动训练系统进行步态信息数据的采集，并比较两组间差异。结果 两组均完成术后1年以上随访，膝关节功能比较：术后3个月随访，HSS组膝关节ROM、HSS评分高于常规组，差异有统计学意义（P0.05）；术后6个月随访，HSS组患者膝关节ROM、HSS评分高于常规组，FJS评分低于常规组，差异有统计学意义（P0.05）；术后1年随访，HSS组的HSS评分高于常规组、FJS评分低于常规组，差异有统计学意义（P0.05）。步态参数比较：术后6个月随访，HSS组的步数、步长及单足支撑相较常规组高，差异有统计学意义（P0.05）；术后1年随访，HSS组的步数、步频、单足支撑相较常规组高，差异有统计学意义（P0.05）。结论 HSS膝关节成形术后康复方案在UKA术后早期可显著改善膝关节功能和步态，有利于UKA术后早期康复。关键词 单髁置换术；术后康复；关节功能；步态中图分类号 R684.3 文献标识码 BEffects of HSS knee rehabilitation program on short-term joint function and gait after unicondylar replacementJin Jun,Qiao Jie,Wu Bin,Zhong Chuanqi,Huo Xiongtao.Department of Arthrology and Trauma Orthopedics,Hubei Provincial Hospital of Traditional Chinese Medicine/Affiliated Hospital of Hubei University of Traditional Chinese Medicine/Hubei Institute of Traditional Chinese Medicine,Wuhan Hubei,430074,ChinaAbstract Objective To investigate the short-term effects of the Hospital for Special Surgery(HSS)knee rehabilitation program on joint function and gait after unicompartmental knee arthroplasty(UKA).Methods A retrospective analysis was performed on 60 patients who underwent UKA in Hubei Provincial Hospital of Traditional Chinese Medicine from January 2018 to June 2021.A total of 30 patients who received rehabilitation treatment according to the HSS knee arthroplasty rehabilitation guidelines were selected as the HSS group.The 30 patients who received conventional rehabilitation program during the same period were selected as the control group.The range of motion(ROM),Hospital for Special Surgery(HSS)score and forgotten joint score(FJS)were recorded at 1 week,3 months,6 months and 1 year after operation.The GaitWatch three-dimensional gait analysis and exercise training system were used to collect gait data at 6 months and 1 year after operation,and the differences between the two groups were compared.Results All patients were followed up for more than 1 year after operation.The ROM and HSS scores of the HSS group were significantly higher than those of the control group at 3 months after operation(P0.05).After 6 months of follow-up,the knee ROM and HSS scores of the HSS group were higher than those of the control group,and the FJS score was lower than that of the control group,and the differences were statistically significant(P0.05).After 1 year of follow-up,the HSS score of the HSS group was higher than that of the control group,and the FJS score was lower than that of control group,and the differences were significant(P0.05).Comparison of gait parameters:The number of steps,step length and single leg support in the HSS group were higher than those in the control group at 6 months after operation,and the difference was statistically significant(P0.05).After one-year follow-up,the number of steps,step frequency,and single leg 论著经验交流*基金项目：湖北省科技计划项目（2017CFC843）；湖北省中医院“五专”建设项目（2018064）作者单位：湖北省中医院/湖北中医药大学附属医院/湖北省中医药研究院关节与创伤科，湖北 武汉，430074.722023 年 08 月第 20 卷 第 4 期生 物 骨 科 材 料 与 临 床 研 究 ORTHOPAEDIC BIOMECHANICS MATERIALS AND CLINICAL STUDYsupport of the HSS group were higher than those of the control group,and the difference was statistically significant(P120；行走及站立训练；单腿站立训练；股四头肌/腘绳肌训练；蹬腿/离心蹬腿/单侧蹬腿练习注：ADL为日常生活能力；SLR为直腿抬高；AROM为主动伸膝活动；AAROM为主动辅助屈膝活动。表2 两组患者术前一般资料的比较组别HSS组常规组t/2值P值例数3030性别（例）男8101.2050.862女2220年龄（岁）64.467.3965.986.510.7550.455病程（年）8.682.879.322.350.8530.398BMI（kg/m2）26.564.9826.174.290.2910.772手术部位（例）左18211.5470.763右129表3 两组患者不同时间膝关节ROM比较（-xs，）组别HSS组常规组t值P值例数3030术后1周108.459.38110.2910.670.7090.481术后3个月120.689.08114.879.762.3870.020术后6个月126.328.56121.599.052.0800.042术后1年128.626.48126.398.411.1500.255表4 两组患者术后不同时间HSS评分比较（-xs，分）组别HSS组常规组t值P值例数3030术后1周47.654.1846.844.260.7430.460术后3个月78.766.2172.196.324.3040.001术后6个月87.577.3682.306.582.9240.005术后1年90.525.5487.354.982.3310.023表5 两组患者不同时间膝关节FJS评分比较（-xs，分）组别HSS组常规组t值P值例数3030术后1周24.565.1823.125.731.0210.311术后3个月15.553.4216.792.841.5280.132术后6个月10.233.3812.753.422.8710.006术后1年7.672.269.252.192.7500.008.742023 年 08 月第 20 卷 第 4 期生 物 骨 科 材 料 与 临 床 研 究 ORTHOPAEDIC BIOMECHANICS MATERIALS AND CLINICAL STUDY支撑相参数均较常规组高（P0.05）；两组间步频比较，差异无统计学意义（P0.05）。术后 1 年随访时，HSS 组患者的步数、步频、单足支撑相参数较常规组高（P0.05）；两组间步长比较，差异无统计学意义（P0.05）。具体数据见表 6。3 讨论随着手术技术的成熟及假体不断改进，UKA技术得到快速发展，近年来已成为单间室膝关节炎的首选手术方法3。相 较 于 全 膝 关 节 置 换 术（total knee arthroplasty,TKA），UKA只处理单间室病变，保留更多的韧带等关节周围组织，胫股关节和髌股关节运动基本接近正常情况，因此更利于术后早期康复锻炼11。良好的术后康复是置换关节获得良好疗效的前提，近年来，随着UKA手术在各大医院的广泛运用，关于UKA术后的康复治疗逐渐受到学者们的重视。有研究报道了加速康复外科管理模式在UKA围手术期的应用12-13，也有学者采用骨科康复一体化治疗模式对UKA的患者进行管理，在术后早期取