类风湿关节炎膝关节置换术后功能康复的疗效分析  

Evaluation of the systematic functional rehabilitation on rheumatoid arthritis patients following total knee arthroplasty

作　　者：韩伟 王锴[2] 张舒 寇伯龙[2] Han Wei;Wang Kai;Zhang Shu;Kou Bolong(Department of Orthopedics,the First People′s Hospital of Dongcheng,Beijing 100075,China;Department of Joint Surgery,Peking University People′s Hospital,Beijing 100044,China)

机构地区：[1]北京市东城区第一人民医院骨科,北京100075 [2]北京大学人民医院骨关节科,北京100044

出　　处：《中华医学杂志》2020年第23期1795-1799,共5页National Medical Journal of China

摘　　要：目的探讨类风湿关节炎患者行全膝关节置换术后功能康复措施及其临床疗效。方法回顾性分析2012年1月到2017年12月200例(259膝)在北京大学人民医院接受膝关节置换术的类风湿关节患者的病例资料。所有患者于初次膝关节置换术后1周进行系统功能康复治疗。具体措施包括健康教育、肌力训练、关节活动度(AROM)训练、平衡功能、步态训练及日常活动训练。根据术后膝关节残存屈曲挛缩角度,将患者分为轻度(≤15°)、中度(15°~30°)、重度(≥30°)3组。对比分析患者功能康复治疗前后的主动膝AROM及最大屈曲、伸直角度的改变情况,患者疼痛情况使用疼痛视觉模拟评分(VAS)评价。比较术后残留不同程度的屈曲挛缩患者恢复情况和术后并发症的情况。利用独立样本t检验进行组间数据比较。结果本组男17例(20膝),女183例(239膝),年龄(57±13)岁,病程(16±10)年。与功能康复治疗前相比,患者出院时屈曲角度、伸直角度、AROM和VAS评分均显著改善(分别为76°±12°比112°±9°、12.9°±10.2°比2.4°±4.6°、63°±15°比110°±10°和3.7±1.2比2.0±0.4,t=39.0、15.1、41.3、21.2,均P<0.01)。康复治疗后,轻度屈曲挛缩中178例(80.2%)膝关节可完全伸直,中重度屈曲挛缩中17例(45.9%)可完全伸直,两者差异具有统计学意义(χ^2=20.15,P<0.01),总体治愈率75.3%。141例患者(70.5%)术后进行康复治疗前出现不同程度的贫血,均经对症处理,但中重度贫血与轻度或无贫血患者相比,住院时间较长[(13±5)d比(11±5)d,t=2.2,P=0.028]。结论功能康复训练是纠正类风湿关节炎患者人工膝关节置换术后残留膝关节挛缩的重要手段,可缓解疼痛,提高患者的生活质量。Objective To evaluate the effects of functional rehabilitation on rheumatoid arthritis patients after the total knee arthroplasty(TKA).Methods Two hundred rheumatoid arthritis patients(259 knees)were enrolled in this study at Arthritis Clinic and Research Center,Peking University People′s Hospital from January 2012 to December 2017.All patients received the primary total knee arthroplasty,followed by a systematic functional rehabilitation.The same procedure of rehabilitation was followed,which consisted of patients′education,resistance training,passive and active range of motion exercise,balance exercise,gait training and daily-activity training.According to the degree of postoperative residual flexion contracture,these patients were divided into three groups:the severe(≥30°),moderate(15°-30°),and mild(≤15°).The outcomes of functional rehabilitation were evaluated among different groups and compared with those before the rehabilitation,which included the active range of motion(AROM),the flexion and extension angle of the knee,pain on the visual analogue scale(VAS).The complications and their impacts on the process of rehabilitation were also studied.Independent t test was applied to compare the data before and after the rehabilitaton.Results There were 17 males(20 knees)and 183 females(239 knees)in this group,aged(57±13)years with a disease course of(16±10)years.There were significant improvements after the functional rehabilitation,including the flexion angle,the extension angle,AROM and pain VAS(76°±12°vs 112°±9°,12.9°±10.2°vs 2.4°±4.6°,63°±15°vs 110°±10°and 3.7±1.2 vs 2.0±0.4,respectively;t=39.0,15.1,41.3,21.2,all P<0.01).The residual flexion contracture after the surgery in 259 knees were all improved,among which 195 knees(75.3%)reached a complete correction.Compared with the mild flexion contracture,the moderate and severe group had a lower complete correction rate(80.2%vs 45.9%,χ^2=20.15,P<0.05).Total of 141 patients(70.5%)suffered from anemia two days after the surgery.By

关 键 词：关节炎 类风湿 关节成形术 置换 膝 康复 

分 类 号：R687.4[医药卫生—骨科学]