光生物調節療法對全膝關節置換術腫脹改善 和恢復促進的影響

Abstract

腫脹是創傷後損傷和手術後常見的問題，對患者的治療效果和康復有顯著影響。本論文探討了在下肢骨折和全膝關節置換術兩種臨床狀況中，評估和處理腫脹的創新方法。 本研究主要有兩個部分，第一部分研究了生物阻抗分析作為評估急性踝關節骨折後腫脹的非侵入性工具的應用。腫脹由急性發炎和微血管通透性上升引起，會延遲手術時機並增加併發症風險。在19名急性踝關節骨折患者中，使用多頻率生物阻抗分析（5–200 kHz）和周徑測量，每12小時進行一次測量，直到手術為止。結果顯示，阻抗值與周徑變化之間具有顯著相關性（r = 0.736），且患肢與健側肢阻抗比值的下降反映了腫脹的惡化。併發症患者的術前阻抗比值較低（0.69比0.82），表明生物阻抗分析是監測軟組織健康的可靠且量化的工具。 第二部分評估了光生物調節療法在減少術後腫脹及改善全膝關節置換患者康復中的作用。在一項隨機對照試驗中，光生物調節療法組每天接受波長為650 nm和850 nm的光療，同時接受標準術後復健。使用生物阻抗分析評估腫脹，並通過2分鐘步行測試、疼痛視覺類比量表和膝關節主動活動範圍測量功能結果。在術後第6天，光生物調節療法組的阻抗比值和2分鐘步行測試距離（27公尺比16公尺，p = 0.009）顯著改善，表明腫脹減輕和行動能力提高。 本研究證實了生物阻抗分析和光生物調節療法作為監測下肢骨折和全膝關節置換術後腫脹的先進工具的潛力。生物阻抗分析能提供精確的腫脹評估，而光生物調節療法能減少水腫並加速康復。這些結果支持將此類技術整合到臨床實踐中以改善患者治療效果，並建議進一步進行大規模研究以驗證其效果。

Swelling, a critical concern following post-traumatic injuries and surgical procedures, significantly impacts patient outcomes and recovery strategies. This dissertation explores innovative approaches to evaluate and manage swelling in two clinical contexts: lower leg fractures and total knee arthroplasty (TKA). The first part investigates the use of bioimpedance analysis (BIA) as a non-invasive tool for assessing post-traumatic swelling in 19 patients with acute ankle fractures. Swelling, driven by inflammatory and microvascular responses, delays surgical intervention and increases complications. Multifrequency BIA (5–200 kHz) and circumferential measurements were performed at 12-hour intervals prior to surgery. Results revealed a strong correlation (r = 0.736) between impedance and circumferential changes, with declining impedance ratios reflecting worsening swelling. Complications were associated with lower preoperative impedance ratios (0.69 vs. 0.82), highlighting BIA as a reliable, quantifiable method for monitoring soft tissue health. The second part evaluates photobiomodulation therapy (PBMT) in reducing postoperative swelling and enhancing recovery in 30 TKA patients. In a randomized controlled trial, the PBMT group received daily light therapy (650 nm and 850 nm wavelengths) alongside standard care. Swelling was assessed using BIA, while functional outcomes were measured through the 2-minute walk test (2MWT), visual analog scale (VAS) for pain, and active range of motion (aROM). PBMT significantly improved impedance ratios and 2MWT distances (27 m vs. 16 m, p = 0.009) by postoperative day 6, indicating reduced swelling and enhanced mobility. This research demonstrates the potential of BIA and PBMT as advanced tools for managing swelling in lower leg fractures and TKA. BIA provides precise swelling assessment, while PBMT reduces edema and accelerates recovery. These findings support integrating these technologies into clinical practice to improve patient outcomes, warranting further large-scale studies for validation.