全膝关节置换术后个性化系统康复的疗效观察  

The observation of outcomes on early postoperative individual rehabilitation following total knee replacement

作　　者：侯来永[1] 王廉[1] 谢欲晓[1] 孙启良[1] 

机构地区：[1]中日友好医院康复科,北京100029

出　　处：《中国康复医学杂志》2008年第8期707-710,共4页Chinese Journal of Rehabilitation Medicine

摘　　要：目的:探讨个性化系统康复对全膝关节置换术(TKR)后功能恢复的作用,以及对术后住院时间的影响。方法:选择TKR手术患者44例,随机分成系统康复训练组(22例)和对照组(22例)。两组均接受骨科常规治疗、护理和功能锻炼指导。康复组除接受骨科常规治疗外,入院后根据患者情况由康复医学科制定个性化系统的康复治疗方案,康复治疗方案分为4个阶段:第一阶段(术前第4天)、第二阶段(术后第0—3天)、第三阶段(术后第4—14天)、第四阶段(术后第15—60天)。康复治疗内容包括呼吸训练、肌力训练、关节活动度训练、平衡功能、本体感觉、步态和独立转移能力训练。于手术治疗前4d,手术后第14天及第60天进行评价,指标包括:美国膝关节学会评分(AKSS)、膝关节活动范围(ROM)、手术后住院天数。结果:康复组和对照组手术前各项观察指标经统计学分析差异无显著性意义(P>0.05),康复组在第14天AKSS关节和功能评分值优于对照组(P<0.05),第60天AKSS关节和功能评分值明显优于对照组(P<0.01),ROM测定值均优于对照组(P<0.01),手术后住院天数短于对照组(P<0.05)。结论:个性化系统康复治疗可促进TKR术后患者的功能恢复;增加手术后膝关节的关节活动范围;缩短患者手术后的住院天数。Objective： To discuss the effects of early postoperative individual rehabilitation following total knee replacement （TKR）. Method： Forty-four patients were randomly divided into rehabilitation group and control group, each 22 subjects. All patients suffered from knee osteoarthritis were underwent the operation in hospital. All patients got the normal nursing care. In addition, the rehabilitation group got the individual rehabilitation systematically. The rehabilitation procedure consisted of four parts：the 1st period was 4d before operation, the 2nd was the 0--3rd d post operation and the 3rd and 4th period were the 4-14th d and 15--60th d respectively. The program included breath exercises, muscle strengthening, passive, active-assisted and active range of motion（ROM） exercises, balance exercises, proprioception exercises, gait training and ability to transfer independently were performed in different periods. Patients were evaluated at the 4th d before operation, the 14th d and the 60th d after operation. The evaluation indexes involved the American Knee Society score（AKSS）, knee range of motion （ROM）, and the duration of hospital staying after operation. Result： All the evaluation indexes had no difference between rehabilitation group and control group before operation（P〉0.05）. At the 14th d after operation, AKSS in rehabilitation group was better than that in control group（P〈0.05） and at the 60th d after operation, AKSS rehabilitation group was much better than that in control group（P〈0.01）.The knee ROM in rehabilitation group was much better than that in control group（P〈0.01）. In rehabilitation group hospital staying duration was less than that in control group（P〈0.01 ）. Conclusion： Individual rehabilitation program could facilitate function restoration and improved range of motion, shortened the duration of hospital staying significantly for the patients after TKR.

关 键 词：康复 全膝关节置换 骨性关节炎 

分 类 号：R49[医药卫生—康复医学]