超早期精细化康复锻炼方案在全膝关节置换术后加速康复中的应用  

Efficacy of super early segmented rehabilitation regimen in enhanced recovery after total knee arthroplasty

作　　者：邱垂明 柯松 王敏 张峡 徐源 QIU Chui-ming;KE Song;WANG Min;ZHANG Xia;XU Yuan(People's Hospital of Tunchang County,Tunchang Hain- an 571600,China;Department of Orthopaedics,Second Affiliated Hospital of Army Medical University,Chongqing 400037,China)

机构地区：[1]屯昌县人民医院骨科,海南屯昌571600 [2]陆军军医大学第二附属医院骨科,重庆400037

出　　处：《局解手术学杂志》2019年第10期825-828,共4页Journal of Regional Anatomy and Operative Surgery

基　　金：国家自然科学基金(81501606)

摘　　要：目的评价全膝关节置换术(TKA)后对患者实施超早期精细化康复锻炼加速膝关节功能康复治疗的效果。方法选取2017年1月至2018年1月在我院行TKA的患者150例,按照手术方案的不同分为对照组与观察组,每组75例。对照组采用常规的术后加速康复(ERAS)方案,观察组采用超早期行为干预+精细化训练+连续被动运动(CPM)的超早期精细化康复锻炼方案。采用视觉模拟评分(VAS)、膝关节屈曲活动范围评分(ROM)、美国特种外科医院膝关节功能评分(HSS)比较2组患者康复期间疼痛、膝关节功能恢复以及并发症发生情况。结果术后7、14 d,观察组VAS明显低于对照组;术后1周以及1、3个月观察组ROM、HSS明显高于对照组;术后3个月观察组并发症发生率(1. 33%)明显低于对照组(6. 67%),以上差异均有统计学意义(P <0. 05)。结论 TKA术后,在快速康复外科理念基础上,采用超早期行为干预+精细化训练+CPM的超早期精细化康复锻炼方案能有效改善患者膝关节的功能,减轻患者术后痛苦,减少并发症,提高患者生活质量。Objective To evaluate the efficacy of super early segmented rehabilitation regimen in the enhanced recovery after total knee arthroplasty ( TKA). Methods Totally 150 patients who underwent TKA in our hospital from January 2017 to January 2018 were selected. According to the different surgical ways,these patients were divided into two groups: the control group ( n =75) and the observation group ( n =75). The conventional regimen of enhanced recovery after surgery ( ERAS) was used in the control group,while the super early segmented rehabilitation regimen of super early behavior intervention combined with fine training and continuous passive motion ( CPM) was carried out in the observation group. The pain and knee fuction recovery of the two groups were compared by visual analogue scale ( VAS),knee range of motion ( ROM) and knee score of American hospital for special surgery ( HSS),and the incidence of complications were assessed. Results At 7 and 14 days after operation,VAS score of the observation group was significantly lower than that in the control group. One week,one month and three months after surgery,ROM and HSS of the observation group were remarkably higher than those in the control group. At three months after surgery,the incidence rate of complications in the observation group ( 1. 33%) was evidently lower than that in the control group ( 6. 67%). The above differences were statistically significant ( P <0. 05). Conclusion After TKA,the super early segmented rehabilitation regimen of super early behavior intervention combined with fine training and CPM on the basis of ERAS can effectively improve the knee func- tion,relieve the postoperative pain and reduce the occurrence of complications,thus promoting the quality of life.

关 键 词：全膝关节置换术 超早期 精细化康复锻炼方案 术后加速康复 行为干预 连续被动运动 

分 类 号：R684.7[医药卫生—骨科学]