多模式镇痛管理联合卧位蹬车运动在全膝关节置换术后康复中的应用效果  

Effectiveness of Multimodal Analgesia Management Combined with Supine Bicycle Exercise in Application of Rehabilitation in Patients after Total Knee Arthroplasty

作　　者：何苗[1] 张皓春[2] 李敏清[1] 赵小秋 耿佳斌 彭庆娟[1] HE Miao;ZHANG Hao-chun;LI Min-qing;ZHAO Xiao-qiu;GENG Jia-bin;PENG Qing-juan(Department of Rehabilitation Medicine,the Central Hospital of Dazhou City,Dazhou,Sichuan 635000,China;Department of Cerebrovascular Disease,the Central Hospital of Dazhou City,Dazhou,Sichuan 635000,China;Orthopaedic Disease Center,the Central Hospital of Dazhou City,Dazhou,Sichuan 635000,China)

机构地区：[1]达州市中心医院康复医学科,四川达州635000 [2]达州市中心医院脑血管病科,四川达州635000 [3]达州市中心医院骨科疾病中心,四川达州635000

出　　处：《临床误诊误治》2022年第3期98-102,共5页Clinical Misdiagnosis & Mistherapy

基　　金：达州科技局项目(19YYJC0011)。

摘　　要：目的探讨多模式镇痛管理联合卧位蹬车运动在全膝关节置换术(TKA)后康复中的应用效果。方法选取2020年1月—2021年5月我院收治的103例行TKA术的膝关节骨性关节炎患者,根据术后治疗方案的不同分为观察组52例和对照组51例,对照组术后给予常规干预,观察组在对照组基础上术后给予多模式镇痛管理联合卧位蹬车运动,直至患者出院。观察2组入院时及术后3、7、14 d患膝美国特种外科医院膝关节评分(HSS)、关节活动度、髌骨中点水平周径、股四头肌肌力、疼痛评分及术后不良事件发生情况。结果术后7、14 d观察组患膝HSS评分、关节活动度、股四头肌肌力评分高于对照组(P<0.01)。术后14 d观察组患膝关节髌骨中点水平周径小于对照组(P<0.01)。术后3、7、14 d观察组患膝疼痛评分低于对照组(P<0.01)。2组术后不良事件总发生率比较差异无统计学意义(P>0.05)。结论多模式镇痛管理联合卧位蹬车运动能有效改善TKA术后患者患膝关节活动度,减轻术后疼痛及患膝肿胀程度,对患膝术后功能恢复具有积极意义,且不会增加不良事件的发生。Objective To explore the effectiveness of multimodal analgesia management combined with supine bicycle exercise in application of rehabilitation in patients after total knee arthroplasty(TKA).Methods A total of 103 patients with knee osteoarthritis(KOA)who had undergone TKA between January 2020 and May 2021 were selected,and the patients were divided into the observation group(n=52)and control group(n=51)according to different postoperative treatments.Control group was given routine intervention after operation,while observation group was given multimodal analgesia management combined with supine bicycle exercise on the basis of treatment for control group until the patients were discharged from the hospital.The knee joint scores of the hospital for special surgery(HSS),joint range of motion(ROM),horizontal circumference of patella center,muscle of strength quadriceps femoris muscle,pain scores and incidence rates of postoperative adverse events were observed at admission and after operation for 3,7 and 14 d in two groups.Results After operation for 7 and 14 d,HSS scores,joint ROM and muscle strength of quadriceps femoris muscle scores in observation group were significantly higher than those in control group(P<0.01).After operation for 14 d,the horizontal circumference of patella center in observation group was significantly smaller than that in control group(P<0.01).Knee pain scores in observation group were significantly lower than those in control group after operation for 3,7 and 14 d(P<0.01).There was no significant difference in the total incidence rate of postoperative adverse events between two groups(P>0.05).Conclusion Multimodal analgesia management combined with supine bicycle exercise may effectively improve the ROM of the affected knee and reduce postoperative pain and swelling degree of the affected knee in patients after TKA,and it has positive significance for the functional recovery of the affected knee without increasing incidence rate of adverse events.

关 键 词：骨关节炎 膝 全膝关节置换术 镇痛 卧位蹬车运动 膝关节活动度 

分 类 号：R687.4[医药卫生—骨科学]