[Key words]Modem rehabilitation;Fractures around the knee;After;Use periprosthetic fractures include femoral condylar fractures, patellar fractures and tibial condylar fractures. These fractures are prone to involve the knee joint function and lead to knee motion disorder, and their postoperative rehabilitation exercises are directly related to the knee function rehabilitation.
1. Data and Methods
1.1 Clinical data
A total of 96 patients with periprosthetic knee fractures were admitted to our hospital from June 2006 to December 2007. 46 cases were randomly selected, 37 males and 9 females, age: 25 to 58 years old, including 5 cases of distal femur fracture I, 9 cases of patella fracture and 22 cases of proximal tibia fracture, with an average hospital stay of 3 months.
1-2 Modern rehabilitation treatment methods
1-2.1 Psychological treatment
Patients were evaluated at the initial stage before treatment, and patients with depression or anxiety were given psychological guidance, music training, etc., to eliminate their mental pressure and make them understand the meaning, purpose and precautions of active participation in functional exercise.
1.2.2 Exercise therapy
① Isometric contraction training: instruct and encourage patients to actively perform isometric contraction training of the quadriceps muscle. Specific practice: ankle dorsiflexion, tense the leg muscles for 5 seconds and then relax, tense again and relax again, 20 times as a group, 3 groups per day, and gradually increase the number of times and extend the time.
② Joint loosening training: Joint loosening training is a special method to move the joints through the therapist. Specific practice: the patient takes a comfortable position, fully relaxed, the therapist first pull and loosen the contracted soft tissues (ligaments, joint capsule) inside and outside the knee joint, then gradually flex the knee with force until the pain point or slightly past the pain point to stop, maintain l5-20 seconds and then relax, repeat 2-3 times, each time the range of knee flexion should be slightly increased, pay attention to pulling the joint moderately, prohibit excessive force, to the pain point after maintaining a period of time.
@CPM machine passive exercise: 45. start, increase by 5. to 10. daily as appropriate according to the patient’s tolerance level, until the knee flexion reaches 120. then you can stop CPM machine exercise. Each passive exercise is 30 minutes, twice a day, and the CPM machine is used slowly to pull the knee joint until it is slightly past the painful point.
After the passive exercise of CPM machine, the patient may have knee swelling and pain, the degree of which should be controlled until the swelling and pain disappears in the morning of the next day after the exercise, if the swelling and pain do not disappear completely, it means that the range of activity on the first day is too much, at this time, only the original range of activity can be maintained, supplemented by physiotherapy to reduce the joint.
1.2-3 Physical factor treatment
①Neuromuscular electrical stimulation: purpose: to maintain or improve muscle strength and muscle volume. Different waveform, amplitude, period and frequency of electrical pulses directly control the intensity of muscle contraction. 50~100HZ, low frequency pulses with a wavelength of 0.1MS or low frequency modulated medium frequency electrical stimulation of the quadriceps muscle, especially the medial femoral muscle, with electrodes placed in parallel along the long axis of the muscle bundle, the stimulation intensity is appropriate to achieve the most human contraction effect with minimum current, 20~30 minutes per treatment, twice a day.
②Interference electrotherapy: purpose: to promote bone healing, improve blood circulation and reduce pain. Specific practice: two sets of electrodes are placed crosswise at the fracture, so that the lesion is in the center of the four electrodes, the electric flow to feel min, energized for 20-30 minutes / time, once a day.
1.2.4 Traditional Chinese medicine treatment
①Chinese medicine fumigation treatment: fumigation method: local fumigation with our homemade Chinese medicine fumigation formula. The main components and usage of Chinese medicine: 20g of ginger, 20g of dahurica, 20g of dahurica, 30g of gentiana, 30g of mulberry, 30g of gentiana, 30g of fangfeng, 30g of kuanjian vine, 30g of haitongpi, 30g of danshen, 30g of yanhu, 20g of wei lingxian, 30g of stretch grass, 30g of qiangwu, 30g of gui zhi, 30g of chuanxiong. add 2000ml of water, boil it for 15 minutes, pour it into a basin and put the affected limb on the basin. The affected limb was set up on the basin and covered with a bath towel for fumigation.
After the temperature of the liquid decreases, put the affected limb into the liquid and soak it, and use the residue to apply hot compresses to the affected area and gently move the joints. Once a day for 30 minutes each time, 7 days for 1 course of treatment.
②Local massage therapy: The patient lies in supine knee extension position, the therapist applies techniques on both sides of the quadriceps and below the knee for 10 minutes, and points such as Liangqiu, Xuehai, and knee eyes, Yanglingquan are pressed. Repeatedly and progressively flex and extend the knee and increase the mobility of the knee joint. If necessary, apply sudden force to passively flex the knee to a certain angle. Apply light kneading and pressure around the knee, ending with a local warming sensation. Once a day, 7 days a course of treatment.
1.3 Effect evaluation
Efficacy evaluation criteria: Referring to Shelboume’s efficacy evaluation criteria, the knee function was divided into four categories, excellent: the knee can be straightened and flexed >120. no pain, can resume the work before the injury, and can participate in general sports activities. Good: the knee can be straightened and flexed 90. to 120. with mild pain, not affecting life and work. OK: Knee flexion 60. to 90. with moderate pain, affecting work and life I II have some difficulty going down stairs. Poor: knee flexion <50., heavy pain, need to take drugs routinely for analgesia, affects daily life, difficulty going up and down stairs....
2. Results
This group of 46 patients used rehabilitation treatment before and after the comparison of joint mobility, pain, self-care of life, the efficacy of reference to the above criteria assessment, including excellent 8 cases, good 32 cases, can 5 cases, poor 2 cases. The excellent rate was >85%.
For the above 46 patients, after systematic and comprehensive modern rehabilitation treatment in our hospital, most of them achieved good rehabilitation results, with an excellent rate > 85%. In one case, the patient was unwilling to actively cooperate with the training and did not obey the therapist’s command during the training, and the treatment time was not sufficient. In the other case, 10 years after the tibial plateau fracture, the knee joint was completely stiff and it was too late for rehabilitation treatment.
3. Discussion
Periprosthetic fractures tend to lead to knee dysfunction, and the closer the fracture is to the knee joint, the more serious the impact on the knee joint. Comprehensive and systematic rehabilitation is beneficial to maintaining the normal range of motion of the knee joint and minimizing the dysfunction of the knee joint , improving the patients’ ability to take care of themselves and reemployment. Postoperative patients’ concerns about long-term function and lack of pain awareness can affect their mood.
Negative emotions, such as anxiety, depression, withdrawal, low self-esteem, and despair, have an impact on the disease process and recovery. Through psychotherapy, we can strengthen the defensive ability of mental activity, correctly understand and treat the disease, eliminate concerns, establish confidence in overcoming the disease, and maximize the active motivation of the patient, so that he or she can actively carry out rehabilitation training. Isometric contraction training can promote blood circulation and maintain the physiological function of the cartilage surface of the knee joint, as well as reduce joint effusion, promote elimination of I』Il prevent adhesions, and promote the recovery of knee joint function.
Continuous CPM passive activity increases the nutrition and metabolism of articular cartilage, accelerates the repair of articular cartilage and periarticular tissues such as tendons and ligaments, and stimulates the transformation of cells with dual differentiation ability into articular cartilage, inhibits joint injury and postoperative patient pain, promotes the self-repair of cartilage injury, and keeps the muscles in a non-contracted state of passive activity, which does not produce the shear stress that causes the fracture end to re-displace after repositioning. Shear stress, avoiding loosening of the internal fixation or displacement of the fracture end ‘. Studies have shown that early postoperative isometric contraction training and passive activity of the CPM machine are more beneficial in improving knee dysfunction.
Joint loosening, especially Maitland’s 4-stage technique, is a very practical and effective technique to prevent joint adhesions, improve joint mobility, and promote the repair of damaged joint cartilage and periarticular tissues. Physical factor therapy such as neuromuscular electrical stimulation and interferential electricity can reduce inflammation, swelling and pain, promote blood circulation in the lower extremities, promote bone healing, excite the bones and promote contraction.
If combined with isometric contraction training, it is more beneficial to the recovery of the knee joint function. Local fumigation can significantly improve symptoms and promote functional recovery. The fumigation formula includes Chuan Sang Sang Sang, which benefits the kidneys and strengthens the muscles and bones, Wei Ling Xian, Gentiana Macrophylla, Fang Feng, Kuan Tendon Vine, Hai Tong Pi, Ha Jiang, Bai Zhi, Zhong Tendon Cao, which dispels wind and dampness, relaxes the tendons and activates the collaterals, and stops paralysis and pain, and Dan Shen, which activates blood circulation and transforms stasis, breaks down stasis and creates new blood.
Tui Na treatment can play a role in unblocking the meridians of the diseased knee, improving the circulation of joint fluid, blood and lymph, promoting the absorption of inflammatory exudation of the joint, effectively enhancing the nutrition of the cartilage cells of the diseased knee, and through the treatment of tendon manipulation can straighten the tendons and bones, regulate the meridians, relax the tendons and activate the channels, with the effect of relieving spasm and analgesia, loosening the adhesions, slipping the joints, improving the blood circulation in the mouth, increasing the blood flow, and promoting the metabolism. It can reduce the internal force of the knee joint, thus restoring the balance of stress and tension in the knee joint and improving the dysfunction of the knee joint.
However, the following issues should be noted in the training: functional exercise should be gradual; active activities should be supplemented by passive activities; avoid premature weight-bearing and walking on the ground; review the X-ray regularly and adjust the exercise plan according to the growth of bone scabs; take into account both the body and local conditions, and pay attention to the activities of other parts of the body while exercising the affected limb; and pay attention to preventing burns when fumigating with Chinese medicine.
In conclusion, modern rehabilitation treatment after periprosthetic fracture has a positive effect on the healing of fracture, recovery of knee function, and improvement of self-care ability and re-employment ability, which is worth promoting.
4. Outlook
It is not uncommon to see patients with severe knee dysfunction after periprosthetic fracture, mainly because the time to enter rehabilitation is too late or the opportunity for active training is too limited.
The development of modern rehabilitation therapy has greatly reduced the degree of functional limitation after periprosthetic fractures, which requires clinicians to refer patients to rehabilitation facilities for modern rehabilitation therapy or to provide reasonable and effective postoperative rehabilitation therapy during hospitalization in general hospitals as early as possible after surgery in order to achieve better functional recovery of the knee joint, and to explore more and better methods and means of rehabilitation and early intervention. There is also a need to explore more and better rehabilitation methods and means, as well as the time criteria and indications for early intervention.