| There are 1,000,000-4,000,000 patients with AS in China. Ankylosed hip is 2% -4% in ankylosing spondylitis, but cases which bilateral hips and knees are simultaneous ankylosed are rare. Report is seldom about bilateral hips and knees replaced in AS patients in a operation abroad, nor precedent of postoperative rehabilitation is retrieved. In the past 5 years, all four joints were replaced in one operation in 20 AS patients whose bilateral hips and knees were ankylosed in our hospital, and rehabilitation were done under the guidances of doctors.1 purposePostoperative effects of joints replaced were Contrast between the modern rehabilitation and traditional rehabilitation in AS patients whose bilateral hips and knees were ankylosed, patients in order to maximizing effect of rehabilitation after joint replacement in AS.2 MethodsAn acute rehabilitation2.1.1 in control groupWe began rehabilitation immediately when patients were awake from anesthesia, isometric muscle training is mainly in lower limbs. its purpose is to prevent deep vein thrombosis. Activities of ankle also were took. Passive activities of hips and knees were took at postoperative 3rd day; postoperative 5-7th day, we began passive functional exercise of hip and knee with CPM. At the same time initiative functional exercises of hips and knees were guided to 2nd week.2.1.2 The experimental group(1) Physical Therapy①Paraffin Paraffin were continued 15-30 minutes before activities daily, the average 20 minutes.②phototherapyPhototherapy were usually last for 4 weeks at joints from postoperative 1st day, 20 minutes every time, 1 time every day.③Ultrasonic TherapyDrugs were penetrated into joints with ultrasound therapy for 1 week at postoperative 1st week, 2 times per day. Continuous medication is made for 30 minutes after passive exercise of joints and then carrying drugs for 40 minutes.④ice treatmentIce treatment was operatively made for 15-20 minutes every time, 2-7 times per day.(2) Exercise Therapy①isometric muscle contractionConscious patients were made passive lower limb massage as ankle pumps for 1 week.②isotonic muscle contractionIsotonic contraction of flexor were carried out operative 1st week; if extension is barrier, we can only make extensor isotonic contraction until the joint fully is extended or the obstacles can not be solved.③joint mobilizationLower limbs were placed at the extensive position in postoperation, sandbags or salt bags were especially placed on the front of the knees so that them can continuously be made knee extension. Laser treatment and paraffin were made for 20 minutes respectively postoperative 1st day after elastic bandages and dressings were opened and then passive range of motion was made. We can make flexion, extension, adduction, subduction of hip and flexion and extension exercises of knee mainly, but also requires collateral ligament and lateral joint capsule stretch of knee. Range of motion increase 5-10 degrees every day, our aim is that flexion of hip can reach for 90 degrees and flexion of knee can surpass 90 degrees within 1 week after surgery. The whole exercise was made by rehabilitation therapist personally.2.2 convalescent rehabilitation2.2.1 in control groupAfter 2 weeks, to encourage patients load and learn to walk by helping walkers, patients can walk 30 steps by the walker before discharge.2.2.2 The experimental groupExperimental group, postoperative recovery following rehabilitation programs(1) Physical Therapy①ParaffinParaffin were continued 15-30 minutes before activities daily, the average 20 minutes.②phototherapyPhototherapy were usually last for 4 weeks at joints, 20 minutes every time, 1 time every day.③medium frequency electrotherapyFrequency electrical stimulation can be intervened from postoperative 2nd weeks. Each course is usually 2 weeks, 1 time every day, interruption for 1 week between the two treatment course.④ice treatmentIce treatment was made for 15-20 minutes every time usually after the passive joints, 2-3 times per day.(2) exercise therapy①joint mobilizationPatellar mobilization was made 20-30 times in each direction. Tensiling joint in the maximum flexion angle was continued for 10-20 minutes. PNF techniques routinely was used for training to promote functional of muscle contraction.②muscle isotonic contractionThis process needs to continue more than 3 months.③sitting balance trainingSitting balance training was began for postoperative 2nd week.④standing balance exercisesElectric stand-bed training continued no more than 20 minutes, when patients gradually adapted state it may be appropriately extended. Standing frame training can be continued for 10-20 minutes each time. Balance bar training can be continued for 2 weeks and 5-20 minutes each time. Dynamic balance and walking aids training can be began after postoperative 1st month.3 ResultsAll passive range of motion of hips and knees in different postoperative periods are higher than those of preoperation, and have significantly different; but the experimental group increased the rate in different periods were significantly higher, and statistically significant. Preoperative hip score and knee score was 0 points, no significant difference. All scores of hips and knees in different periods were significantly improved and the difference was significant; but the improved rate of the experimental group was significantly greater than the rate of control group in different times, and statistically significant. After surgery, 6 in 20 hips of the control group had pain, 7 in 20 knees had pain, 4 hips and 5 knees left pain after 6 months, 4 cases required analgesics after walking, 1 patient left bilateral knee pain; 3 in 20 hips left pain in experimental group, 4 in 20 knees left pain, 1 left hip pain after 6 months, 3 knees left joint pain, there are 2 cases need to take painkillers after the walk. In control group, 3 postoperative deep venous thrombosis was detected, no lower extremity deep venous thrombosis was detected in the experimental group. 2 fixity hip flexion deformity occured in control group, but less than 30°, 2 cases occured knee flexion deformity, 1 surpassed 10°, the experimental group no hip deformity occured, but 1 patient had 30°flexion deformity; unequel length of double-limb did not occur in two groups. In control group, 2 patients were unable to walk after surgery, 7 cases can walk with walkers, and 4 can walk with crutches, 4 can walk with a cane, 3 patients could walk away from the cane; in experimental group, 1 patients was unable to walk after surgery , 5 cases can walk with walkers, and 3 can walk with crutches, 3 can walk with a cane, 8 patients could walk away from the cane. Hip, knee was stable. Some relatively poor muscle in control group, half of the patients were good, while the experimental group, most of the cases are basically the major muscles are more than good.4 Conclusion1. Postoperative rehabilitation was effective in AS whose bilateral hip and knee ankylosed were made 4 joints replacement in 1 surgery.2. Under the guidance of the modern concept of rehabilitation, AS patients with bilateral hip and knee replacement surgery were more effective than traditional rehabilitation significantly improved efficacy. |
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