《中国康复理论与实践》

《中国康复理论与实践》

• 临床研究 • 上一篇    下一篇

个体化术前康复对全膝关节置换术后6 周功能转归的影响①

杨延砚1a，吴同绚1a，张巧云1a，周谋望1a，李子剑1b，张克1b，陈仲强1b   

  1. 1.北京大学第三医院，a.康复科；b.骨科，北京市100191。
  • 出版日期:2016-06-25 发布日期:2016-07-04

Effects of Individual Prehabilitation on Functional Outcome SixWeeks after Total Knee Arthroplasty

YANG Yan- yan1a, WU Tong- xuan1a, ZHANG Qiao- yun1a, ZHOU Mou- wang1a, LI Zi- jian1b, ZHANG Ke1b, CHEN Zhong-qiang1b   

  1. 1. a. Department of Rehabilitation Medicine; b. Department of Orthopaedics, Peking University 3rd Hospital, Beijing 100191, China
  • Published:2016-06-25 Online:2016-07-04

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摘要： 目的观察个体化术前康复对全膝关节置换术(TKA)后6 周功能转归的影响。方法2013 年3 月~2015 年8 月，将拟行TKA的患者随机分为术前康复组(n=30)和对照组(n=29)。术前康复组从入组开始进行个体化康复训练，对照组无术前康复干预。两组患者入院后均接受常规术前康复教育、手术治疗及术后康复治疗。分别在入组时、术前3 d 内和术后6 周采用疼痛数字分级量表(NRS)、关节主动活动范围(AROM)、徒手肌力检查(MMT)、跌倒指数、计时“起立-行走” 测试(TUG)和特种外科医院膝关节评分(HSS-KS)进行评定。结果两组患者术后6 周的NRS评分均低于术前(t>2.342, P<0.05)，术前康复组的NRS评分在术前及术后6 周均明显低于对照组(t>2.827, P<0.01)。两组患者术侧膝屈曲AROM在入组时和术前无显著性差异(t<0.648, P>0.05)，术后6 周时对照组AROM较入组时和术前均明显增加(t>3.555, P<0.01)，术前康复组无显著性差异(t<1.608, P>0.05)；对照组的术侧膝伸展AROM在术前增大(Z=-2.257, P=0.024)，术前康复组无显著性差异(Z=0, P=1.000)，两组术侧膝伸展AROM在术后6 周时较入组时和术前均降低(Z>2.247, P<0.05)。术前康复组的躯干屈伸肌群肌力在术前均增强(t>2.387, P<0.05)，对照组无显著性差异(t<0.940, P>0.05)；两组躯干后伸肌群肌力及腹直肌上段肌力在术后6 周时无显著性差异(t<1.656, P>0.05)，术前康复组的腹直肌下段及腹外斜肌肌力在术后6 周时大于对照组(t=2.585, P=0.013)。两组患者的跌倒指数在入组及术前无显著性差异(t<0.350, P>0.05)，术后6 周时术前康复组明显低于对照组(t=-2.837, P=0.007)。术前康复组的TUG时间在术前明显缩短(t=3.554, P=0.002)，对照组则显著延长(t=-4.507, P<0.001)，两组在术后6 周无显著性差异(t=-0.497, P=0.622)。术前康复组HSS-KS评分在术前升高(t=-2.621, P=0.015)，对照组无显著性差异(t=2.073, P=0.053)，术前康复组HSS-KS评分在术前及术后6 周均高于对照组(t>2.092, P<0.05)。结论个体化术前康复能够在TKA术前减轻患者疼痛，提高患者躯干屈伸肌群肌力、步行能力及膝关节整体功能表现；能够在TKA术后6 周使患者疼痛减轻，躯干屈肌群肌力、立位平衡能力及膝关节整体功能提高。

关键词: 膝骨关节炎, 全膝关节置换术, 个体化术前康复, 数字分级量表, 主动活动范围, 徒手肌力检查, 跌倒指数

Abstract: Objective To observe the effects of individual prehabilitation on the functional outcome six weeks after total knee arthroplasty (TKA). Methods The patients undergoing TKA from March, 2013 to August, 2015 were randomly divided into prehabilitation group (n= 30) and control group (n=29). The prehabilitation group received individual rehabilitation since enrolled in the study. The control group received no prehabilitation. All the patients received regular pre-surgical education, surgery and post-surgical rehabilitation. Both groups were evaluated with Numerical Rating Scale (NRS) of pain, active range of motion (AROM), Manual Muscle Test (MMT), fall index, Timed "Up and Go" (TUG), and Hospital for Special Surgery-Knee Scale (HSS-KS). Results The scores of NRS reduced six weeks after TKA (t>2.342, P<0.05) in both groups, and was lower in the prehabilitation group than in the control group before and six weeks after TKA (t>2.827, P< 0.01). There was no significant difference in AROM of knee flexion when enrolling and before TKA in both groups (t<0.648, P>0.05), and it increased in the control group six weeks after TKA (t>3.555, P<0.01), and no increasement was found in the prehabilitation group (t< 1.608, P>0.05); the AROM of knee extension increased before TKA in the control group (Z=-2.257, P=0.024), and no increasement was found in the prehabilitation group (Z=0, P=1.000), and it decreased six weeks after TKA in both groups (Z>2.247, P<0.05). The muscle strength of trunk extention and flexion enhanced before TKA in the prehabilitation group (t>2.387, P<0.05), and no change was found in the control group (t<0.940, P>0.05). The muscle strength of trunk extensor and the upside of rectus abdominis showed no statistical difference between two groups six weeks after TKA (t<1.656, P>0.05), the muscle strength of the downside of rectus abdominis and external oblique was more in the prehabilitation group than in the control group (t=2.585, P=0.013). There was no significant difference in the fall index be- fore TKA (t<0.350, P>0.05), and it was lower in the prehabilitation group than in the control group six weeks after TKA (t=-2.837, P= 0.007). The time of TUG shortened before TKA in the prehabilitation group (t=3.554, P=0.002), and it prolonged in the control group (t=-4.507, P<0.001), there was no significant difference in it between two groups six weeks after TKA (t=-0.497, P=0.622). The score of HSS-KS increased before TKA (t=-2.621, P=0.015) in the prehabilitation group, and no increasement was found in the control group (t= 2.073, P=0.053), and they were higher in the prehabilitation group than in the control group before and six weeks after TKA (t>2.092, P< 0.05). Conclusion Individual prehabilitation could reduce pain, and improve the trunk muscles, the ability of walking and the function of the knee before and six weeks after TKA.

Key words: knee osteoarthritis, total knee arthroplasty, individual prehabilitation, Numerical Rating Scale, active range of motion, Manual Muscle Test, fall index