机构：[a]Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China骨科首都医科大学宣武医院[b]Department of Orthopedics, Beijing Jishuitan Hospital, No.31 East Street, Beijing, China[c]School of Biomedical Engineering, Capital Medical University, No.10 Xi Tou Tiao, Youanmen wai, Fengtai District, Beijing, China[d]Department of Radiology, Beijing Youan Hospital, Capital Medical University, No.8 Xi Tou Tiao, Youanmen wai, Fengtai District, Beijing, China
Background: The main objective of total knee arthroplasty is to relieve pain, restore normal knee function, and improve gait stability. Significant flexion contractures can severely impair function after surgery. The purpose of this study is to evaluate the efficacy of implementing a continuous proximal sciatic nerve block in conjunction with aggressive physical therapy to treat patients with persistent flexion contractures that were recalcitrant to rehabilitation efforts following primary total knee arthroplasty (TKA). Methods: From December 2012 to January 2016, the following subjects were enrolled in this study: 20 patients (15 females and 5 males aged between 62 and 78 years old; median age = 65.7 y) with flexion contractures ranging from 15 degrees to 25 degrees (19.2 degrees +/- 5.6 degrees) that persisted for at least 1.5 months following total knee arthroplasty and showed no significant improvement in response to conventional therapeutic methods. Demographic data, the passive range of motion, flexion contracture, pain score during stretching, and the Hospital for Special Surgery knee score were recorded. A portable motion analyzer was used to obtain the corresponding gait parameters from the flexion contractures group and control group. Repeated measurement ANOVA was used to compare the clinical results. Results: In combination with 2 to 4 (2.5 +/- 1.3) months of aggressive knee stretching exercises, 16 out of 18 knees achieved full extension, and 2 out of 18 improved to within 5 degrees of the full extension. An average of the 12 to 48 (26.6 +/- 10.7) month follow-up showed that this improved range of motion was maintained for all the corresponding patients, and that there were no reoccurrences of deformity. The mean Hospital for Special Surgery knee scores improved from 61.2 to 93.2 points (p < 0.001). After six months of continuous proximal sciatic nerve blockage, all gait parameters for the flexion contractures group exhibited significant improvement. Conclusion: A continuous proximal sciatic nerve block could be a useful adjunct to a physical therapy regimen for patients with knee flexion contractures, especially for patients with difficult-to-treat cases of knee flexion contracture that are recalcitrant to conservative therapy.
基金：
Capital's Funds for Health Improvement and Research, China [2018-2-2012]
第一作者机构：[a]Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China[b]Department of Orthopedics, Beijing Jishuitan Hospital, No.31 East Street, Beijing, China
通讯作者：
通讯机构：[a]Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China
推荐引用方式(GB/T 7714)：
Meng Zhou,Shuai An,Mingli Feng,et al.Gait analysis of patients with continuous proximal sciatic nerve blockade in flexion contractures after primary total knee arthroplasty[J].GAIT & POSTURE.2018,66:166-171.doi:10.1016/j.gaitpost.2018.08.021.
APA：
Meng Zhou,Shuai An,Mingli Feng,Zheng Li,Huiliang Shen...&Guanglei Cao.(2018).Gait analysis of patients with continuous proximal sciatic nerve blockade in flexion contractures after primary total knee arthroplasty.GAIT & POSTURE,66,
MLA：
Meng Zhou,et al."Gait analysis of patients with continuous proximal sciatic nerve blockade in flexion contractures after primary total knee arthroplasty".GAIT & POSTURE 66.(2018):166-171
