Clinical Study Of Early Application Of CPM After Surgery Of Fractures Around Knee Joint

Objective: Fractures around knee joint are quite common clinically, owing to traffic accident, sport injury, fall or aging osteoporosis. It often requires surgery treatment after this kind of fracture. Post-operative joint rehabilitation is of greatest importance to avoid joint stiffness. Continuous passive motion(CPM), as one method of joint rehabilitation, has been widely used. However, some of recent clinical studies showed that CPM might have no clinical significance in the rehabilitation of fracture patients around knee joint. This study applied early CPM on the fracture patients around knee joints to receive early joint passive exercise, then evaluated the rehabilitation of knee joint, to investigate the efficacy of early CPM on the rehabilitation of knee joint.Methods: 53 patients with fractures around knee joint were enrolled in this study. All patients were ambulatory and had no joint functional problems before fracture. They all received operation treatment in Suzhou High-tech Zone Hospital of Integrated Traditional and Western Medicine between January 2013 and June 2014. They all received open reduction and strong internal fixation, furthermore, open reduction reached the standard of anatomical reduction and there was no plasters, splint or other external fixation. All patients were randomly divided into CPM group(26 cases) and control group(27 cases). In CPM group, there were 15 males and 11 females, with the average age at 50.15±12. 58 y. The patients in CPM group received CPM from the second day after surgery. CPM were performed twice a day, 2h once, from the degree of 30 at the beginning to 90 at 2 weeks. Meanwhile, they performed isometric contractions of quadriceps muscle, flexion and extension of ankle and knee joint from the day after surgery. In Control group, there were 12 males and 15 females, with the average age at 49.04±11.41 y. The patients in control group performed the same exercises except for CPM. The rate of post-operative complication, fracture union and internal fixation condition, the range of motion(ROM) were compared between two groups at time of 1, 2, 6 weeks and 3, 6 months; AKS scores were compared at 3 and 6 months; VAS pain score and distinctions of perimeter of shank between fracture leg and healthy leg of each patient were compared at 1, 2 weeks.Results: At the aspect of the rate of post-operative complication, fracture union and internal fixation condition, there was no significance between two groups at 1, 2, 6 weeks and 3, 6 months. At the aspect of the degree of extension, there was no significance between CPM group and control group at all time points(P>0.05); at the aspect of the degree of flexion, the CPM group had better flexion than control group at 1, 2, and 6 weeks and 3 months(P<0.05), while there is no significance at 6 months(P>0.05). At the aspect of AKS, the rate of excellence and good was 88.5% for CPM group, better than 63.0% for control group at 3 months(P<0.05). The rate of excellence and good was 96.15% for study group and 96.29% for control group at 6 months, with no significance(P>0.05). At the aspect of VAS pain score, the CPM group had less pain than control group at 1, 2 weeks. At the aspect of distinctions of perimeter of shank between fracture leg and healthy leg of each patient, CPM group had smaller distinctions than control group at 1, 2 weeks.Conclusions: Early application of CPM in patients with fractures around knee joints, in addition to regular muscle exercises, would increase the ROM of knee joints, relieve the swelling and pain, and improve the life quality of patients.