山东大学学报 (医学版) ›› 2024, Vol. 62 ›› Issue (10): 1-7.doi: 10.6040/j.issn.1671-7554.0.2024.1024
• 骨科加速康复外科专题 •
刘培来*,李学州*,卢群山,孙厚义,杨杰,李哲
LIU Peilai*, LI Xuezhou*, LU Qunshan, SUN Houyi, YANG Jie, LI Zhe
摘要： 系统总结膝关节置换术后康复过程中的常用康复器具及其在不同康复阶段的作用。膝关节置换术是治疗膝关节骨关节炎的主要手段,术后康复对患者的功能恢复和生活质量改善至关重要。根据康复的不同阶段,将术后康复目标分为缓解疼痛和减少肿胀、恢复关节活动度、增强肌肉力量以及改善步态和平衡,并详细介绍了各阶段常用的康复器具,如冷疗装置、患者自主控制镇痛泵、连续被动运动机、经皮电刺激仪、神经肌肉电刺激仪、步态训练设备等。尽管部分器具的疗效存在争议,尤其是在疼痛管理和关节活动度恢复方面,但它们在加速术后康复和提升患者满意度方面展现出一定的积极作用。随着虚拟现实技术和机器人辅助康复设备的应用前景逐步展现,未来个性化康复方案将进一步优化患者的康复体验与效果。
中图分类号:
| [1] Li D, Li S, Chen Q, et al. The prevalence of symptomatic knee osteoarthritis in relation to age, sex, area, region, and body mass index in China: a systematic review and Meta-analysis[J]. Front Med(Lausanne), 2020, 16(7): 304. [2] Canovas F, Dagneaux L. Quality of life after total knee arthroplasty[J]. Orthop Traumatol Surg Res, 2018,104(1S): S41-S46. [3] Dunbar MJ, Richardson G, Robertsson O. I cant get no satisfaction after my total knee replacement: rhymes and reasons[J]. Bone Joint J, 2013, 95-B(11 Suppl a): 148-152. [4] Mistry JB, Elmallah RD, Bhave A, et al. Rehabilitative guidelines after total knee arthroplasty: a review[J]. J Knee Surg, 2016, 29(3): 201-217. [5] Yang X, Li GH, Wang HJ, et al. Continuous passive motion after total knee arthroplasty: a systematic review and meta-analysis of associated effects on clinical outcomes[J]. Arch Phys Med Rehabil, 2019, 100(9): 1763-1778. [6] Aggarwal A, Adie S, Harris IA, et al. Cryotherapy following total knee replacement[J]. Cochrane Database Syst Rev, 2023, 9(9): CD007911. [7] Yue C, Zhang X, Zhu Y, et al. Systematic review of three electrical stimulation techniques for rehabilitation after total knee arthroplasty[J]. J Arthroplasty, 2018, 33(7): 2330-2337. [8] Fukui J, Matsui Y, Mizuno T, et al. Comparison of gait analysis before and after unilateral total knee arthroplasty for knee osteoarthritis[J]. J Orthop Surg Res, 2024,19(1): 506. [9] Schaubel HJ. The local use of ice after orthopedic procedures[J]. Am J Surg, 1946, 72(5): 711-714. [10] Lee JM, Warren MP, Mason SM. Effects of ice on nerve conduction velocity[J]. Physiotherapy, 1978, 64(1): 2-6. [11] 刘玉, 张楠心, 戴丽群, 等. 全膝关节置换后冷疗有效性的Meta分析[J]. 中国组织工程研究, 2020, 24(9): 1443-1448. [12] Wyatt PB, Nelson CT, Cyrus JW, et al. The role of cryotherapy after total knee arthroplasty: a systematic review[J]. J Arthroplasty, 2023, 38(5): 950-956. [13] Dundon JM, Rymer MC, Johnson RM. Total patellar skin loss from cryotherapy after total knee arthroplasty[J]. J Arthroplasty, 2013, 28(2): 375-377. [14] Li JW, Ma YS, Xiao LK. Postoperative pain management in total knee arthroplasty[J]. Orthop Surg, 2019, 11(5): 755-761. [15] Walder B, Schafer M, Henzi I, et al. Efficacy and safety of patient-controlled opioid analgesia for acute postoperative pain. a quantitative systematic review[J]. Acta Anaesthesiol Scand, 2001, 45(7): 795-804. [16] Motamed C. Clinical update on patient-controlled analgesia for acute postoperative pain[J]. Pharmacy(Basel), 2022, 10(1): 22. [17] Franzoni S, Rossi S, Cassinadri A, et al. Perioperative pain management in total knee arthroplasty: a narrative review of current multimodal analgesia protocols[J]. 2023, 13(6): 3798. [18] Zhu Y, Feng Y, Peng L. Effect of transcutaneous electrical nerve stimulation for pain control after total knee arthroplasty: a systematic review and meta-analysis[J]. J Rehabil Med, 2017, 49(9): 700-704. [19] 李凯明, 李玲慧, 梁龙, 等. 经皮电刺激改善全膝关节置换术后疼痛与功能的系统评价与Meta分析[J]. 海南医学院学报, 2019, 25(24): 1872-1877. [20] Vance CGT, Dailey DL, Chimenti RL, et al. Using TENS for pain control: update on the state of the evidence[J]. Medicina(Kaunas), 2022, 58(10): 1332. [21] Li J, Song Y. Transcutaneous electrical nerve stimulation for postoperative pain control after total knee arthroplasty: a meta-analysis of randomized controlled trials[J]. Medicine(Baltimore), 2017, 96(37): e8036. [22] 司建洛, 杨木强, 司马靓杰, 等. 经皮电刺激耳神门穴对全膝关节置换后镇痛效果的影响[J]. 中国组织工程研究. 2017, 21(27): 4294-4299. [23] Jauregui JJ, Cherian JJ, Gwam CU, et al. A meta-analysis of transcutaneous electrical nerve stimulation for chronic low back pain[J]. Surg Technol Int, 2016, 28: 296-302. [24] Salter RB, Simmonds DF, Malcolm BW, et al. The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage. An experimental investigation in the rabbit[J]. J Bone Joint Surg Am, 1980, 62(8): 1232-1251. [25] Harvey LA, Brosseau L, Herbert RD. Continuous passive motion following total knee arthroplasty in people with arthritis[J]. Cochrane Database Syst Rev, 2014, 2014(2): Cd004260. [26] Liao CD, Huang YC, Lin LF, et al. Continuous passive motion and its effects on knee flexion after total knee arthroplasty in patients with knee osteoarthritis[J]. Knee Surg Sports Traumatol Arthrosc, 2016, 24(8): 2578-2586. [27] Gil-González S, Barja-Rodríguez RA, López-Pujol A, et al. Continuous passive motion not affect the knee motion and the surgical wound aspect after total knee arthroplasty[J]. J Orthop Surg Res, 2022, 17(1): 25. [28] Jia ZF, Zhang Y, Zhang WP, et al. Efficacy and safety of continuous passive motion and physical therapy in recovery from knee arthroplasty: a systematic review and meta-analysis[J]. J Orthop Surg Res, 2024, 19(1): 68. [29] Denis M, Moffet H, Caron F, et al. Effectiveness of continuous passive motion and conventional physical therapy after total knee arthroplasty: a randomized clinical trial[J]. Physical Therapy, 2006, 86(2): 174-185. [30] Wirries N, Ezechieli M, Stimpel K, et al. Impact of continuous passive motion on rehabilitation following total knee arthroplasty[J]. Physiother Res Int, 2020, 25(4): e1869. [31] Monaghan B, Caulfield B, OMathúna DP. Surface neuromuscular electrical stimulation for quadriceps strengthening pre and post total knee replacement[J]. Cochrane Database Syst Rev, 2010, 2010(1): Cd007177. [32] Stevens-Lapsley JE, Balter JE, Wolfe P, et al. Early neuromuscular electrical stimulation to improve quadriceps muscle strength after total knee arthroplasty: a randomized controlled trial[J]. Phys Ther, 2012, 92(2): 210-226. [33] Klika AK, Yakubek G, Piuzzi N, et al. Neuromuscular electrical stimulation use after total knee arthroplasty improves early return to function: a randomized trial[J]. J Knee Surg, 2022, 35(1): 104-111. [34] Labanca L, Bonsanto F, Raffa D, et al. Does adding neuromuscular electrical stimulation to rehabilitation following total knee arthroplasty lead to a better quadriceps muscle strength recovery? a systematic review[J]. Int J Rehabil Res, 2022, 45(2): 118-125. [35] Monsegue AP, Emans P, van Loon LJC, et al. Resistance exercise training to improve post-operative rehabilitation in knee arthroplasty patients: a narrative review[J]. Eur J Sport Sci, 2024, 24(7): 938-949. [36] Valtonen A, Pöyhönen T, Sipilä S, et al. Effects of aquatic resistance training on mobility limitation and lower-limb impairments after knee replacement[J]. Arch Phys Med Rehabil, 2010, 91(6): 833-839. [37] Valtonen A, Pöyhönen T, Sipilä S, et al. Maintenance of aquatic training-induced benefits on mobility and lower-extremity muscles among persons with unilateral knee replacement[J]. Arch Phys Med Rehabil, 2011, 92(12): 1944-1950. [38] Lee CH, Kim IH. Aquatic exercise and land exercise treatments after total knee replacement arthroplasty in elderly women: a comparative study[J]. Medicina(Kaunas), 2021, 57(6): 589. [39] Giaquinto S, Ciotola E, Dall’Armi V, et al. Hydrotherapy after total knee arthroplasty. a follow-up study[J]. Arch Gerontol Geriatr, 2010, 51(1): 59-63. [40] Kim S, Hsu FC, Groban L, et al. A pilot study of aquatic prehabilitation in adults with knee osteoarthritis undergoing total knee arthroplasty - short term outcome[J]. BMC Musculoskelet Disord, 2021, 22(1): 388. [41] Elbaz A, Mor A, Segal G, et al. Novel classification of knee osteoarthritis severity based on spatiotemporal gait analysis[J]. Osteoarthritis Cartilage, 2014, 22(3): 457-463. [42] Knowlton CB, Lundberg HJ, Wimmer MA, et al. Can a gait-dependent model predict wear on retrieved total knee arthroplasty components?[J]. Bone Joint J, 2020, 102-b(6_Supple_A): 129-137. [43] Yeung S, Kim HK, Carleton A, et al. Integrating wearables and modelling for monitoring rehabilitation following total knee joint replacement[J]. Comput Methods Programs Biomed, 2022, 225: 107063. doi:10.1016/j.cmpb.2022.107063. [44] 赵伟, 苏鹏, 张力, 等. 三维步态分析在髋膝关节置换术中的应用[J]. 中国矫形外科杂志, 2022, 30(20): 1863-1867. [45] Rühling M, Kirschbaum SM, Perka C, et al. Increased ankle pain after total knee arthroplasty is associated with a preoperative lateralized gait and talar tilt, but not with ankle laxity or the range of motion of the subtalar joint[J]. Bone Joint J, 2023, 105-b(11): 1159-1167. [46] Pua YH, Liang Z, Ong PH, et al. Associations of knee extensor strength and standing balance with physical function in knee osteoarthritis[J]. Arthritis Care Res(Hoboken), 2011, 63(12): 1706-1714. [47] Domínguez-Navarro F, Silvestre-Muñoz A, Igual-Camacho C, et al. A randomized controlled trial assessing the effects of preoperative strengthening plus balance training on balance and functional outcome up to 1 year following total knee replacement[J]. Knee Surg Sports Traumatol Arthrosc, 2021, 29(3): 838-848. [48] Yau WP. Corr insights®: No benefit to sensor-guided balancing compared with freehand balancing in TKA: a randomized controlled trial[J]. Clin Orthop Relat Res, 2022, 480(8): 1545-1546. [49] Gazendam A, Zhu M, Chang Y, et al. Virtual reality rehabilitation following total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials[J]. Knee Surg Sports Traumatol Arthrosc, 2022, 30(8): 2548-2555. [50] 高海香, 王蕾, 陈萍, 等. 虚拟现实技术对全膝关节置换术后患者康复锻炼镇痛与康复效果的影响[J]. 中华疼痛学杂志. 2023, 19(5): 764-769. [51] Gür O, Ba?瘙塂ar S. The effect of virtual reality on pain, kinesiophobia and function in total knee arthroplasty patients: a randomized controlled trial[J]. Knee, 2023, 45: 187-197. doi:10.1016/j.knee.2023.09.012. [52] Pournajaf S, Goffredo M, Pellicciari L, et al. Effect of balance training using virtual reality-based serious games in individuals with total knee replacement: a randomized controlled trial[J]. Ann Phys Rehabil Med, 2022, 65(6): 101609. [53] Koo KI, Hwang CH. Five-day rehabilitation of patients undergoing total knee arthroplasty using an end-effector gait robot as a neuromodulation blending tool for deafferentation, weight offloading and stereotyped movement: Interim analysis[J]. PLoS One, 2020, 15(12): e0241117. [54] Yoshikawa K, Mutsuzaki H, Sano A, et al. Training with hybrid assistive limb for walking function after total knee arthroplasty[J]. J Orthop Surg Res, 2018, 13(1): 163. [55] Kotani N, Morishita T, Saita K, et al. Feasibility of supplemental robot-assisted knee flexion exercise following total knee arthroplasty[J]. J Back Musculoskelet Rehabil, 2020, 33(3): 413-421. [56] Wu K, Pan HH, Lin CH. Robotic exoskeletons and total knee arthroplasty: the future of knee rehabilitation and replacement-a meta-analysis[J]. Medicine(Baltimore), 2024, 103(17): e37876. |
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