Effect of Rehabilitation Training Based on Mechanics Concept Combined with Ilizarov Technical Orthopedics on Knee Joint Stability and Lower Limb Weight Bearing in Elderly Patients with Knee Osteoarthritis
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摘要:
目的 探讨基于力学理念的康复训练联合Ilizarov技术矫形对老年膝骨关节炎患者膝关节功能、稳定性和下肢负重的影响。 方法 回顾性研究唐山市第二医院骨伤科2019年12月至2021年6月收治的120例60岁以上膝骨关节炎患者临床资料，所有患者均按照治疗方法不同分为观察组和对照组，对照组接受Ilizarov技术矫形干预，观察组接受基于力学理念的康复训练联合Ilizarov技术矫形干预。测量并比较2组患者术前及术后不同时期（3个月、6个月、12个月）的膝关节功能[美国膝关节协会量表（KSS）评分、美国特种外科医院（HSS）膝关节功能系统评分、膝关节活动度（ROM）]、疼痛程度[疼痛视觉模拟评分（VAS）]、下肢负重位力学轴线[髋-膝-踝角（HKA）和胫股角（FTA）]。 结果 2组患者术后3个月、6个月、12个月稳定性、活动度及总分维度等不同方面KSS评分均持续升高，疼痛、缺陷扣分等维度持续下降，且组间差异有统计学意义（P < 0.05）。2组患者术后3个月、6个月、12个月膝关节ROM及HSS评分均持续升高，而VAS评分则持续下降，且组间差异有统计学意义（P < 0.05）。2组患者术后3个月、6个月、12个月下肢负重位HKA持续增大，FTA持续减小，且组间差异有统计学意义（P < 0.05）。 结论 基于力学理念的康复训练联合Ilizarov技术矫形能够快速缓解老年膝骨关节炎患者的疼痛症状，提升其膝关节活动度、稳定性，矫正下肢负重位力学轴线，改善膝关节功能。 Abstract:Objective To investigate the effect of rehabilitation training based on mechanical concepts combined with Ilizarov technical orthopedics on knee joint function, stability and lower limb weight bearing in elderly patients with knee osteoarthritis. Methods This study is a retrospective clinical study. 120 patients with knee osteoarthritis over 60 years old who were admitted to the Department of Orthopedics and Traumatology in our hospital from December 2019 to June 2021 were selected as the research subjects. All patients were divided into observation group and control group, according to different treatment methods. The control group received Ilizarov technical orthopedic intervention, and the observation group received rehabilitation training based on mechanics concepts combined with Ilizarov technical orthopedic intervention. We measured and compared the knee function of the two groups of patients before and after surgery at different periods （3 months, 6 months, 12 months） [American Knee Society Scale （KSS） score, American Hospital for Special Surgery （HSS） Knee Joint function system score, knee range of motion （ROM） ], pain level [visual analog scale （VAS） for pain], lower extremity weight-bearing mechanical axis [hip-knee-ankle angle （HKA） and tibiofemoral angle （FTA）] . Results The KSS scores of patients in the two groups continued to increase in different aspects such as stability, range of motion and total score at 3 months, 6 months and 12 months after operation, while the pain, defect deduction and other dimensions continued to decrease, and there were differences between the groups. Significant （P < 0.05）. The knee ROM and HSS scores of the two groups continued to increase at 3 months, 6 months, and 12 months after operation, while the VAS score continued to decrease, and the difference between the two groups was significant （P < 0.05）. At 3 months, 6 months, and 12 months after the operation, the HKA of the lower extremity weight-bearing position continued to increase, and the FTA continued to decrease, and the differences between the two groups were significant （P < 0.05）. Conclusion Rehabilitation training based on the mechanics concept combined with Ilizarov technical orthopedics can quickly relieve the pain symptoms of elderly patients with knee osteoarthritis, improve their knee joint mobility and stability, correct the mechanical axis of the lower limbs’ weight-bearing position, and improve knee joint function. -
图 1 典型病例
A：伤后左膝关节正侧位X线片示膝关节内翻畸形、胫骨平台向后半脱位；B：入院后手术前双下肢全长正位X线片；C：入院后手术前CT检查示膝关节胫骨平台前内侧塌陷（红色圈）以及既往内侧副韧带修补手术痕迹（黄色圈）；D：手术后正侧位X 线片示内翻畸形纠正、PTSA恢复、胫骨平台向后半脱位改善；E：手术后3个月正侧位以及双下肢全长X线片示截骨愈合、胫骨平台前内侧骨缺损修复，膝关节残余内翻畸形；F：手术后6个月侧位X线片；G：手术后12个月双下肢全长X线片示内翻畸形纠正。
Figure 1. Typical case
表 1 2组患者的一般资料比较（
$ \bar{x} \pm s $ ）Table 1. Comparison of general data between the two groups （
$ \bar{x} \pm s $ ）组别 性别（n） 年龄
（岁）体质量指数
（kg/m2）Lysholm评分
（分）病程
（a）患侧（n） KL分级（n） 男 女 左 右 双 Ⅰ Ⅱ Ⅲ 观察组（n = 60） 36 24 68.03 ± 5.19 23.11 ± 3.29 42.93 ± 6.01 2.43 ± 1.28 27 26 7 17 33 10 对照组（n = 60） 33 27 67.13 ± 4.92 23.36 ± 2.88 44.01 ± 5.28 2.50 ± 1.42 25 29 6 18 31 11 χ2/t 0.307 0.975 0.443 1.046 0.284 0.318 0.139 P 0.580 0.332 0.659 0.298 0.777 0.853 0.933 
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表 2 患者不同时间KSS评分对比（
$ \bar{x} \pm s $ ，分）Table 2. Comparison of KSS scores of patients at different times （
$ \bar{x} \pm s $ ，points）项目 观察组 对照组 术前t/P 术后3个月t/P 术后6个月t/P 术后12个月t/P 术前 术后3个月 术后6个月 术后12个月 术前 术后3个月 术后6个月 术后12个月 KSS总分 58.53 ± 2.56 67.97 ± 3.01 79.47 ± 3.61 85.71 ± 5.47 59.46 ± 3.56 63.37 ± 3.45 70.19 ± 4.83 79.35 ± 5.58 1.643/0.142 7.782/< 0.001* 11.921/< 0.001* 6.305/0.001* 疼痛 39.34 ± 2.09 34.06 ± 2.11 27.18 ± 3.02 22.75 ± 3.15 38.46 ± 2.25 35.74 ± 2.73 30.62 ± 3.24 27.84 ± 4.63 2.220/0.053 3.772/0.031* 6.016/0.001* 7.041/< 0.001* 稳定性 10.04 ± 0.95 19.34 ± 1.33 28.56 ± 3.02 37.09 ± 2.00 10.14 ± 1.05 15.36 ± 1.73 18.52 ± 3.56 25.37 ± 4.16 0.547/0.798 14.128/< 0.001* 16.659/< 0.001* 7.746/< 0.001* 活动度 8.15 ± 0.77 14.77 ± 1.03 20.79 ± 2.38 29.71 ± 1.79 8.21 ± 0.94 11.38 ± 1.21 17.34 ± 2.83 20.35 ± 3.19 0.382/0.982 16.525/< 0.001* 7.227/< 0.001* 8.292/< 0.001* 缺陷扣分 3.78 ± 0.96 2.06 ± 0.87 1.92 ± 0.65 1.81 ± 0.37 3.47 ± 0.82 2.74 ± 0.73 2.36 ± 0.68 2.07 ± 0.52 1.902/0.094 17.846/< 0.001* 3.623/0.019* 9.847/< 0.001* *P < 0.05。
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表 3 患者不同时间ROM、HSS及VAS评分比较（
$ \bar{x} \pm s $ ，分）Table 3. Comparison of ROM，HSS and VAS scores of patients at different times （
$ \bar{x} \pm s $ ，points）项目 观察组 对照组 术前t/P 术后3个月t/P 术后6个月t/P 术后12个月t/P 术前 术后3个月 术后6个月 术后12个月 术前 术后3个月 术后6个月 术后12个月 R0M（°） 87.56 ± 9.59 103.65 ± 6.57 108.71 ± 6.93 115.56 ± 6.54 88.16 ± 8.94 93.36 ± 8.35 99.34 ± 7.69 104.68 ± 7.83 0.354/0.516 7.502/< 0.001* 7.011/< 0.001* 8.261/< 0.001* HSS评分 63.72 ± 6.64 74.47 ± 5.14 80.67 ± 5.21 87.51 ± 4.27 66.14 ± 7.44 70.07 ± 6.47 74.74 ± 6.13 81.27 ± 5.73 1.880/0.397 4.125/0.062 5.710/0.001* 6.375/< 0.001* VAS评分 7.41 ± 2.12 6.27 ± 2.32 4.75 ± 1.58 2.42 ± 1.64 7.24 ± 2.11 6.96 ± 2.03 6.52 ± 1.87 6.07 ± 1.16 0.440/0.330 1.734/0.892 5.600/0.001* 14.074/< 0.001* *P < 0.05。
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表 4 患者不同时间下肢负重位HKA和FTA角比较（
$ \bar{x} \pm s $ ，°）Table 4. Comparison of HKA and FTA angles of lower limb weight bearing position of patients at different times （
$ \bar{x} \pm s $ ，°）项目 组别 术前 术后3个月 术后6个月 术后12个月 F P HKA 观察组 171.62 ± 4.43 173.37 ± 3.25 176.83 ± 2.75 178.63 ± 1.71 32.32 < 0.001* 对照组 172.21 ± 5.23 172.72 ± 3.16 175.61 ± 3.58 179.13 ± 2.37 18.636 < 0.001* t 1.928 1.734 1.934 0.962 P 0.058 0.088 0.052 0.063 FTA 观察组 182.46 ± 3.28 180.42 ± 3.12 176.58 ± 4.23 174.52 ± 4.45 33.38 < 0.001* 对照组 179.84 ± 3.63 177.42 ± 3.65 176.06 ± 4.73 176.73 ± 4.25 15.373 < 0.001* t 0.667 1.111 2.093 1.325 P 0.083 0.068 0.052 0.059 t 3.63 4.839 2.635 2.782 P 0.002* < 0.001* 0.028* 0.008* *P < 0.05。
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[1] 张洪逵,陈国华,叶壮益. 膝骨关节炎发生的影响因素分析[J]. 实用中西医结合临床,2018,18(7):120-121. doi: 10.13638/j.issn.1671-4040.2018.07.064 [2] 陈浩城. 关节镜下关节清理术联合腔内注射玻璃酸钠治疗膝关节骨性关节炎临床效果及膝关节功能评价[J]. 陕西医学杂志,2018,47(3):344-346. doi: 10.3969/j.issn.1000-7377.2018.03.022 [3] Bandak E,Boesen M,Bliddal H,et al. The effect of exercise therapy on inflammatory activity assessed by MRI in knee osteoarthritis: Secondary outcomes from a randomized controlled trial[J]. The Knee,2021,28(22):256-265. [4] 黄继超. 不同程度负重对膝骨关节炎患者动态膝外翻及下肢稳定性影响的研究[D]. 成都: 成都体育学院, 2019. [5] El-Gafary K,El-Adly W,Farouk O,et al. Management of high-energy tibial plateau fractures by Ilizarov external fixator[J]. European Orthopaedics& Traumatology,2014,5(1):9-14. [6] 郑学建,秦泗河,石磊,等. Ilizarov技术治疗股骨短缩伴膝关节畸形的临床研究[J]. 中华骨与关节外科杂志,2021,14(6):480-484. doi: 10.3969/j.issn.2095-9958.2021.06.05 [7] Gupta S,Sunil G. Management of tibial metaphyseal fractures by hybrid external fixator[J]. Open Journal of Orthopedics,2014,4(3):84-89. doi: 10.4236/ojo.2014.43014 [8] 刘锋卫,刘礼初,秦泗河,等. Ilizarov技术治疗中老年膝骨关节炎内侧间室疼痛的临床观察[J]. 中国骨质疏松杂志,2017,23(2):5. [9] 刘静. 中国老年膝关节骨关节炎诊疗及智能矫形康复专家共识[J]. 临床外科杂志,2019,27(12):95-100. [10] 丁凯,陈伟,杨伟杰,等. 股骨骨折后残留内/外翻畸形愈合对膝关节生物力学影响的有限元分析[J]. 中华老年骨科与康复电子杂志,2020,6(5):257-264. doi: 10.3877/cma.j.issn.2096-0263.2020.05.003 [11] 王华,周才胜,张坤. 骨水泥联合Ilizarov技术对胫骨慢性骨髓炎患者患肢功能及伤口细菌含量的影响[J]. 河北医学,2019,25(4):43-48. [12] Karim M R,Jiao J,Dohmen T,et al. DeepKneeExplainer:Explainable knee osteoarthritis diagnosis from radiographs and magnetic resonance imaging[J]. IEEE Access,2021,37(9):39757-39780. [13] 中国医院协会临床新技术应用专业委员会,中华医学会骨科学分会关节外科学组,中国医师协会骨科医师分会骨关节炎学组. 中国膝关节周围截骨下肢力线矫正术治疗膝关节骨关节炎临床指南[J]. 中华骨科杂志,2021,41(23):18. [14] 刘敏,李腊梅. 在加速康复外科理念的指导下对接受膝关节镜手术后的患者进行康复治疗的效果分析[J]. 当代医药论丛,2020,18(7):50-52. [15] 陈志坚,周雪明,刘世帧,等. 微创髋关节置换术对膝骨性关节炎关节功能及关节炎症的影响[J]. 新医学,2019,50(9):5. [16] Farooq U , Javed S , Ahmad I , et al. Functional outcome of complex tibial plateau fractures managed with closed ilizarov[J]. Journal of the Pakistan Medical Association, 2014, 64（12 Suppl 2）: 104-107. [17] 何欣. 探讨下肢生物力学矫正联合脊柱区核心肌群训练对慢性非特异性下腰痛患者的治疗效果[J]. 名医,2019,6(5):92. [18] 徐家旋,段戡,梅其杰,等. 膝关节均衡手法对全膝关节置换术后患者康复的影响[J]. 河北中医,2019,41(5):749-752. [19] Gubin A V,Borzunov D Y,Malkova T A. The Ilizarov paradigm: thirty years with the Ilizarov method,current concerns and future research[J]. International Orthopaedics,2013,37(8):587-590. [20] Uivaraseanu B,Bungau S,Tit D,et al. Orthopedic surgery approach with uncemented metallic prosthesis in knee osteoarthritis increases the quality of life of young patients[J]. Experimental and Therapeutic Medicine,2021,21(5):541. doi: 10.3892/etm.2021.9973 [21] 刘刚. 有限矫形手术联合Ilizarov技术治疗青少年先天性马蹄内翻足的临床分析[J]. 中国伤残医学,2020,28(13):2. doi: 10.13214/j.cnki.cjotadm.2020.13.029 [22] 张力,苏鹏,樊渝波,等. 胫骨近端截骨Ilizarov技术治疗膝骨性关节炎的步态分析[J]. 中国矫形外科杂志,2021,29(1):5. [23] 张力,苏鹏,樊渝波,等. 胫骨近端截骨Ilizarov技术治疗膝骨性关节炎的步态分析[J]. 中国矫形外科杂志,2021,29(1):50-54. [24] Aktuglu K,Erol K,Vahabi A. Ilizarov bone transport and treatment of critical-sized tibial bone defects: a narrative review[J]. Journal of Orthopaedics and Traumatology,2019,20(1):22. doi: 10.1186/s10195-019-0527-1 [25] Rosteius T,Ptzholz S,Rausch V,et al. Ilizarov bone transport using an intramedullary cable transportation system in the treatment of tibial bone defects[J]. Injury,2020,52(6):1606-1613. [26] Kouzelis A,Vrachnis I N,Vris A,et al. A novel treatment of a 65-year-old woman with a neglected type iiib open fracture of the tibia with inadequate soft tissue coverage and periosteal stripping requiring an ilizarov approach to bone and soft tissue lengthening and reconstruction: a case report and review of the literature[J]. Am J Case Rep,2020,28(7):241. [27] Kouzelis A. Ilizarov trifocal lengthening followed by intramedullary nailing for massive posttraumatic tibial bone defects[J]. Acta Orthopaedica Belgica,2013,79(6):706-710. [28] Abdelkhalek M,El-Alfy B,Ali A M. Ilizarov bone transport versus fibular graft for reconstruction of tibial bone defects in children[J]. Journal of Pediatric Orthopaedics-part B,2016,25(6):1. -
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