术后首次下床活动时间对全膝关节置换术患者下肢肌力的影响  

Effect of early ambulation time in lower limbs muscle strength in patients with total knee arthroplasty

作　　者：朱倩兰[1] 金佳[2] 宋宏晖[2] 艾红珍[1] Zhu Qianlan;Jin Jia;Song Honghui;Ai Hongzhen(Department of Nursing,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Department of Joint Surgery,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China)

机构地区：[1]苏州大学附属第二医院护理部,215004 [2]苏州大学附属第二医院关节外科,215004

出　　处：《中国实用护理杂志》2021年第31期2420-2425,共6页Chinese Journal of Practical Nursing

基　　金：苏州大学附属第二医院青年职工预研基金(SDFEYQN1820)。

摘　　要：目的探讨术后首次下床活动时间对全膝关节置换术患者下肢肌力和跌倒恐惧的影响,为促进全膝关节置换术患者术后康复提供依据。方法将2018年7月至2019年12月苏州大学附属第二医院收治的210例行单侧全膝关节置换术患者按照随机数字表法分为试验1组、试验2组和试验3组,每组70例,分别于术后16、20、24 h开始首次下床活动。术后1周、术后1个月、术后3个月比较3组患者屈、伸肌群的峰力矩(PT)和腘绳肌与股四头肌肌力比率(H/Q);采用修订版跌倒效能量表(MFES)评价患者跌倒效能,单条目法比较3组患者跌倒恐惧发生率。结果术后1个月,试验1组和试验2组屈、伸肌群PT、H/Q分别为(18.73±5.49)N·m、(37.56±7.76)N·m、(48.08±9.19)%和(18.44±5.27)N·m、(37.04±7.07)N·m、(47.49±9.30)%,明显高于试验3组的(16.38±2.85)N·m、(33.75±6.75)N·m、(43.48±7.17)%,差异有统计学意义(t值为2.316~3.057,P<0.05)。术后1周,试验1组跌倒恐惧发生率为72.3%(47/65),MFES得分为(3.14±0.58)分,试验2组和试验3组分别为53.7%(36/67)、(3.81±0.65)分和50.8%(32/63)、(3.87±0.74)分,试验1组跌倒恐惧发生率明显高于试验2组和试验3组,MFES得分明显低于试验2组和试验3组,差异有统计学意义(χ^(2)值为5.780、4.878,t值为6.221、6.129,P<0.05)。结论全膝关节置换术患者术后20 h开始下床活动,可以缩短下肢肌力恢复时间和降低患者跌倒恐惧发生风险。Objective To investigate the effect of early ambulation time on lower limbs muscle strength and fear of falling in patients with total knee arthroplasty,so as to provide basis for promoting the postoperative rehabilitation of patients undergoing total knee arthroplasty.Methods A total of 210 patients after unilateral total knee replacement from July 2018 to December 2019 in the Second Affiliated Hospital of Soochow University were included and assigned to experimental group 1,experimental group 2 and experimental group 3 by random digits table method,each group contained 70 cases,and the patients began ambulation at 16,20,24 hours after knee replacement,respectively.The peak torque(PT)of knee joints flexors and extensor as well as hamstrings quadriceps ratio(H/Q)were compared among three groups at 1 week,1 month and 3 months after knee replacement.The fall efficiency was evaluted by Modified Fall Efficacy Scale(MFES),the fear of falling rate was conducted by single item method.Results After 1 month of knee replacement,the PT of knee joints flexor and extensor and H/Q were(18.73±5.49)N·m,(37.56±7.76)N·m,(48.08±9.19)%and(18.44±5.27)N·m,(37.04±7.07)N·m,(47.49±9.30)%in the experimental group 1 and experimental group 2,which were higher than those in the experimental group 3(16.38±2.85)N·m,(33.75±6.75)N·m,(43.48±7.17)%,the differences were statically significant(t values were 2.316-3.057,P<0.05).After 1 week of knee replacement,the fear of falling rate were 72.3%(47/65)and MFES scores were(3.14±0.58)points in the experimental group 1,53.7%(36/67),(3.81±0.65)points and 50.8%(32/63),(3.87±0.74)points in the experimental group 2 and experimental group 3,the fear of falling rate significantly increased and MFES scores significantly decreased in the experimental group 1 compared to the experimental group 2 and experimental group 3,the differences were statistically significant(χ^(2) values were 5.780,4.878,t values were 6.221,6.129,P<0.05).Conclusions Twenty hours after knee replacement is the best time

关 键 词：全膝关节置换术 早期下床活动 下肢肌力 跌倒恐惧 

分 类 号：R473.6[医药卫生—护理学]