全膝关节置换术前康复训练效果的系统评价  

Efficacy of preoperative rehabilitation for total knee replacement:a systematic review

作　　者：张慧 郝雪云 帅婷[2] 邓永鸿 曾子[2] 宋国敏[3] 

机构地区：[1]天津中医药大学研究生院,天津300193 [2]天津中医药大学护理学院,天津300193 [3]天津市天津医院护理部,天津400211

出　　处：《中国循证医学杂志》2017年第9期1060-1065,共6页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价术前康复训练对全膝关节置换患者术后的效果。方法计算机检索The Cochrane Library、EMbase、Pub Med、CBM、CNKI和Wan Fang Data数据库,搜集有关全膝关节置换术前康复训练效果的随机对照试验(RCT),检索时限均从建库至2017年1月。由2名研究者独立筛选文献,提取相关数据并评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果最终共纳入13个RCT,共745例患者。Meta分析结果显示,术前康复训练组在术后计时"起立-行走"(TUG)测试评分[6周:MD=–1.31,95%CI(–2.29,–0.32),P=0.009;3个月:MD=–1.59,95%CI(–2.03,–1.15),P<0.000 01]和术后3个月膝屈曲活动范围(ROM)评分[MD=4.75,95%CI(0.63,8.86),P=0.02]方面明显高于常规活动组,术后疼痛(VAS)评分明显低于常规活动组[MD=–0.95,95%CI(–1.70,–0.20),P=0.01]。但两组患者在术后西安大略和麦马斯特大学骨性关节炎指数可视化量表(WOMAC)评分[MD=–5.61,95%CI(–12.84,1.62),P=0.13]、SF-36量表评分[MD=13.15,95%CI(–10.51,36.81),P=0.28]、伸展ROM评分[6周:MD=0.60,95%CI(–1.02,2.21),P=0.47;3个月:MD=–2.76,95%CI(–8.45,2.92),P=0.34]、膝关节功能(HSS)评分[MD=0.54,95%CI(–0.46,1.54),P=0.29]及6分钟测试评分[MD=–8.75,95%CI(–51.53,34.03),P=0.69]方面差异均无统计学意义。结论现有证据表明,术前康复训练在一定程度上能改善术后膝关节功能,缓解患者疼痛程度。受纳入研究的数量和质量所限,上述结论尚需开展更多高质量研究予以验证。Objective To systematically review the efficacy of preoperative rehabilitation for patients with total knee replacement. Methods Electronic databases including The Cochrane Library, EMbase, PubMed, CBM, CNKI and WanFang Data were searched to collect randomized controlled trials （RCTs） about preoperative rehabilitation for total knee replacement from inception to January 2017. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then RevMan 5.3 software was used to perform meta-analysis. Results A total of 13 RCTs involving 745 patients were included. The results of meta-analysis showed that, the TUG scores （6 weeks： MD=-I.31, 95%CI -2.29 to -0.32, P=0.009; 3 months： MD=-1.59, 95%CI -2.03 to -1.15, P〈0.000 01）, 3 months knee flexion ROM scores （MD=4.75, 95%CI 0.63 to 8.86, P=0.02） in the preoperative rehabilitation group were higher than those in the control group. The 3 months VAS scores （MD=-0.95, 95%CI -1.70 to -0.20, P=0.01） in the preoperative rehabilitation group was lower than that in the control group. There were no statistical differences between two groups in WOMAC scores （MD=-5.61, 95%CI -12.84 to 1.62, P=0.13）, SF-36 scores （MD=13.15, 95%CI -10.51 to 36.81, P=0.28）, knee extension ROM scores （6 weeks： MD=0.60, 95%CI -1.02 to 2.21, P=0.47; 3 months： MD=-2.76, 95%CI -8.45 to 2.92, P=0.34）, HSS scores （MD=0.54, 95%CI -0.46 to 1.54, P=0.29）, and 6 minutes test scores （MD=-8.75, 95%CI -51.53 to34.03, P=0.69）. Conclusion function after operation and more high-quality studies are Current evidence shows that preoperative rehabilitation can improve the postoperative knee significantly reduce the pain. Due to limited quality and quantity of the included studies, needed to verify above conclusion.

关 键 词：术前 康复 全膝关节置换术 系统评价 META分析 随机对照试验 

分 类 号：R687.4[医药卫生—骨科学]