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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