背景:患者通常被指示在术后6-12周内避免胫骨近端负重,以避免骨折内固定失败。然而,延迟承重导致延迟的移动性,导致日常活动困难;疼痛等问题,有限的膝盖ROM,股四头肌肌力降低,在长期随访中报告了受损的功能结局。本研究主要旨在评估可行性并探索影响大小。次要目的是确定早期负重以及常规理疗对功能结局的有效性。
方法:一项单盲先导随机对照试验,有30名胫骨近端I型参与者,II,纳入和III级骨折;使用基于计算机的软件将其随机分组.7名患者失访。第一组接受早期负重和常规理疗,而第二组接受限制性负重和常规理疗。术后第3天(POD-03)进行评估,在放电时,在6周,在12周。手术后立即记录射线照片,在放电时,在12周。
结果:全尺寸RCT是可行的,其效应大小在0.3-0.7之间。两组术后12周的所有结局指标均具有统计学意义(p<0.05);干预组的差异更为明显。除了股四头肌等长肌力外,两组在12周后的所有结果指标均具有统计学上的显着差异(p<0.05)。
结论:对I型手术患者进行早期负重和常规理疗的全面RCT,II,Ⅲ级胫骨近端骨折是可行的。早期负重以及常规理疗可对减轻患者的疼痛感觉和增加膝关节活动度产生积极影响。股四头肌等距肌力,膝关节功能,和生活质量没有任何不良影响。
背景:ClinicalTrialsRegistry.gov(CTRI/2022/10/046797)。
BACKGROUND: Patients are often instructed to avoid weight bearing on the proximal tibia for 6 - 12 weeks post-surgery to avoid fracture fixation failure. However, delayed weight bearing leads to delayed mobility, causing difficulties in daily activities; problems such as pain, limited knee ROM, reduced quadriceps muscle strength, and impaired functional outcomes are reported in long-term follow-up. This study primarily aimed to evaluate the feasibility and explore the effect size. The secondary aim was to determine the effectiveness of early weight bearing along with conventional physiotherapy on functional outcomes.
METHODS: A single-blinded pilot randomized controlled trial with 30 participants with proximal tibia type I, II, and III fractures were included; they were randomized using computer-based software. Seven patients were lost to follow-up. Group I received early weight bearing along with conventional physiotherapy whereas Group II received restricted weight bearing along with conventional physiotherapy. Assessments were made on post-operative day 3 (POD-03), at discharge, at 6 weeks, and at 12 weeks. Radiographs were recorded immediately after the operation, at discharge, and at 12 weeks.
RESULTS: A full-scale RCT is feasible with an effect size between 0.3 - 0.7. A statistically significant difference (p < 0.05) was found within both groups 12 weeks post-surgery in all outcome measures; the difference was more prominent in the intervention group. A statistically significant difference (p < 0.05) was found between both the groups post-12 weeks in all outcome measures except quadriceps isometric muscle strength.
CONCLUSIONS: A full-scale RCT for early weight bearing along with conventional physiotherapy for patients operated for Type I, II, and III proximal tibia fracture is feasible. Early weight bearing along with conventional physiotherapy could have a positive effect on reducing patient\'s pain perception and increasing knee joint mobility, quadriceps isometric muscle strength, knee function, and quality of life without any adverse effects.
BACKGROUND: ClinicalTrialsRegistry.gov (CTRI/2022/10/046797).