全膝关节置换术后患肢不同体位对肢体肿胀与关节活动度的影响

Effects of knee positions on limb swelling and range of motion after total knee arthroplasty

摘要:

目的：探究全膝关节置换术后患肢的不同摆放体位对术后患肢肿胀与关节活动度的影响。方法：纳入2014年6月至2016年6月于重庆医科大学附属第一医院骨科接受初次单侧全膝关节置换术的100名患者，随机分为2组，每组50例。A组：术后将患肢置于髋关节屈曲30°、膝关节屈曲30°的自制抬高垫上。B组：术后将患肢置于髋关节屈曲30°、膝关节屈曲60°的自制抬高垫上。抬高72 h后观测患肢肿胀程度、皮下血肿面积、水泡及皮温情况，并记录膝关节被动与主动屈曲角度。结果：2组患者肢体肿胀程度、皮下血肿面积、水泡及皮温差异有统计学意义（P<0.05）。2组患者关节活动度比较，最大被动关节屈曲度差异无统计学意义（P=0.072），最大主动关节屈曲度差异有统计学意义（P=0.023）。结论：全膝关节置换术后屈髋30°、屈膝30°比屈髋30°、屈膝60°更有利于减轻患肢肿胀，增加患肢主动活动度。

Abstract:

Objective：To explore the effect of postoperative limb positions on limb swelling and range of motion after total knee arthroplasty. Methods：Between June 2014 to June 2016，100 patients in our hospital who received primary total knee arthroplasty were recruited and randomly divided into two groups（n=50）. In the Group A，50 patients had their lower limb placed with the hip flexed 30° and the knee mild flexed 30° for the first 72 h after operation. In the Group B，50 patients had their lower limb placed with the hip flexed 30° and the knee high flexed 60° for the first 72 h after operation. Degree of swelling，subcutaneous ecchymosis area，the number of blister and skin temperature after 72h were observed，and angles of passive flexion and active flexion of the operated knee were recorded. Results：There were statistically significant differences in the degree of lower limb swelling，subcutaneous ecchy－mosis area，number of the blister，and skin temperature between two groups（P<0.05）. There was also a significant difference in the angles of active flexion of the operated knee（98°±8.91° vs. 83°±7.65°，P=0.023），while there was no significant difference in the angles of passive flexion（115°±12.16° vs. 110°±10.38°，P=0.072） between two groups. Conclusion：Findings of this study indicate that postoperative position of the hip by 30°，with the knee flexed 30°，is more effective than the position hip flexed 30°with the knee flexed 60°，in alleviating knee swelling and increasing range of motion.