Effect of Placing Drainage or Not on Rapid Rehabilitation after Primary Total Knee Arthroplasty / 中国康复理论与实践

Objective:To explore the effect of placing drainage or not on rapid rehabilitation after total knee arthroplasty (TKA). Methods:From January, 2018 to September, 2020, 80 patients with knee osteoarthritis who underwent primary TKA in our hospital were analyzed retrospectively, and they were divided into groups A and B, with 40 cases in each group. Drainage was placed routinely in group A and not in group B. The postoperative serum inflammatory factors, postoperative pain score, postoperative complication rate, postoperative time out of bed, hospital stay, knee function score, range of motion of knee and World Health Organization Quality Of Life-abbreviated version score (WHOQOL-BREF) were compared between two groups. Results:There was no significant difference in the levels of C-reactive protein between two groups on the 1st to 3rd day after operation (t < 0.410, P > 0.05). There was no significant difference in Visual Analogue Score between two groups from 12 h to 48 h after operation (t < 0.300, P > 0.05). The incidences of postoperative complications were 5.0% in group A and 2.5% in group B, with no significant difference between two groups (χ2 = 0.346, P > 0.05). The time of getting out of bed and hospital stay was significantly shorter in group B than in group A (t > 4.863, P < 0.001). The scores of knee joint function, range of motion of knee and WHOQOL-BREF significantly increased after operation in both groups (t > 6.099, P < 0.001), however, there was no significant difference between two groups (P > 0.05). Conclusion:Placement or non-placement of drainage after primary TKA does not affect postoperative complications, knee joint function and quality of life of patients with knee osteoarthritis, however, non-placement of drainage can promote postoperative recovery and discharge.

Correlation of Social-psychological Health and Joint Function in Patients during Rehabilitation for Joint Impairment / 中国康复理论与实践

Objective:To explore the influence of social-psychological factors on outcome of joint rehabilitation. Methods:From October, 2015 to April, 2017, 64 inpatients accepting joint rehabilitation were divided into anxiety group and non-anxiety group, and depression group and non-depression group, according to the scores of Hamilton Anxiety Scale and Hamilton Depression Scale. They were assessed with routine joint scores as initial and final stages of joint rehabilitation, as well as Symptom Checklist-90 (SCL-90) and World Health Organization Disability Assessment Schedule 2.0 (WHO-DAS 2.0). The correlation of joint scores to scores of SCL-90 and WHO-DAS 2.0 was analyzed with Spearman correlation analysis. Results:There were significant differences in joint scores between the depression and the non-depression groups initially and finally (|t| > 2.106, P < 0.05). The joint score at the initial stage was negatively correlated with the interpersonal factor score of SCL-90 (r = -0.257, P < 0.05). The joint score at the final stage was negatively correlated (P < 0.05) with the dimension one (r = -0.257) and four (r = -0.278) of WHO-DAS 2.0, total score (r = -0.263), and interpersonal (r = -0.328) and hostile (r = -0.385) factor scores of SCL-90. Improvement of joint score negative correlated with dimension one of WHO-DAS 2.0 score (r = -0.249, P < 0.05). Conclusion:The social-psychological factors affect the outcome of joint rehabilitation. It is necessary to explore the way to take the the social-psychological assessment into the routine three stage evaluation of the joint rehabilitation protocol.

The therapeutic effect analysis of three kinds of methods for the management of post traumatic knee stiffness / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate the therapeutic effect of rehabilitation, arthroscopy and "hybrid technique" for posttraumatic knee stiffness (PTKS), and to make the best choice for the treatment.</p><p><b>METHODS</b>From February 2004 to November 2009, 66 patients suffered from PTKS were treated, and the clinical data were studied retrospectively, 36 male and 30 female patients with an average age of 41 years were analyzed, knee stiffness time averaged 15 months (0.5 - 108.0 months), 21 cases of patients were treated with rehabilitation (rehabilitation group), 22 cases of patients with arthroscopy + rehabilitation (arthroscopy group) and 23 cases of patients with mini-invasive "hybrid technique" + rehabilitation (hybrid technique group). For each case, the difference of range of motion (ROM) and hospital for special surgery (HSS) score of the knee before and after the treatment were analyzed statistically. The characters of PTKS including the course of the disease, the degree of extensor mechanism involving, physical examination and other ancillary data were also analyzed. The management methods for PTKS were summarized.</p><p><b>RESULTS</b>Total 66 cases were followed up ranging from 24.0-72.5 months and the mean time was 34.2 months. The average ROM was improved obviously: rehabilitation group increased from 45° ± 22° to 95° ± 24° (t = -11.2, P < 0.05), arthroscopy group from 47° ± 26° to 118° ± 11° (t = -11.0, P < 0.05) and hybrid technique group from 36° ± 22° to 110° ± 14° (t = -13.4, P < 0.05). Both ROM and HSS score of the knee before and after the treatment for each group showed significant difference statistically (t = -9.1, -6.0, -5.2, P < 0.05). Wound necrosis, tearing, re-fracture and extension lag were not found. According to Judet standard at final follow-up, 15 cases were excellent, 3 cases good and 3 cases normal in rehabilitation group; 15 cases were excellent, 5 cases good and 2 cases normal in arthroscopy group; 14 cases were excellent, 8 cases good and 1 case bad.</p><p><b>CONCLUSIONS</b>Pathology of PTKS is complex, satisfactory result could be obtained through individualized treatment program, which were established depend on the course of the disease, the degree of extensor mechanism involving, physical examination and ancillary data. The timely and effective surgical interference followed by a comprehensive rehabilitation program is the key point for satisfied outcome.</p>

The treatment of dorsally displaced intra-articular fractures of the distal radius via palmar approach / 中华外科杂志

<p><b>OBJECTIVE</b>To treat dorsally displaced intra-articular fractures of the distal radius, and to assess the integrity of radiocarpal joint and the reliability of stable fixation fracture.</p><p><b>METHODS</b>Sixty-three cases (65 sides) patients with dorsally displaced intra-articular fractures of the distal radius were performed operatively with the open reduction and internal fixation via palmar approach between August 2003 and May 2008. The series included 20 males (21 sides) and 43 females (44 sides). The mean age of patients was 52.4 years ranging from 18 to 82 years. According to the Frykman classification, 6 sides were of type III, 8 of type IV, 5 of type V, 4 of type VI, 13 of type VII and 29 of type VIII. With the exception of the radiocarpal arthrography and the standard antero-posterior and lateral views of the wrist joint, two new tangential antero-posterior and lateral views of the wrist joint were intraoperatively described so as to observe the relation of the distal screws with the articular surface.</p><p><b>RESULTS</b>The 53 cases (54 sides) of the 63 cases (65 sides) were followed up, and the follow-up time was averagely 16.4 months ranging from 4 to 47 months. According to Gartland and Werley criteria, 32 sides were rated as excellent (59.3%), 14 sides as good (25.9%), 7 fair (13.0%) and 1 poor (1.8%), and the excellent-good rate was 85.2%. Observing the new tangential antero-posterior and lateral views of the wrist joint, it showed that screws appeared penetrating into the radiocarpal joint in 26 of the 42 sides by standard antero-posterior view and in 31 of the 42 sides by standard lateral view.</p><p><b>CONCLUSION</b>This palmar approach represents a simple and valuable treatment methodology for the most frequent types of unstable fractures of the distal radius in young and elderly patients.</p>