骨科康复一体化模式对全膝关节置换术患者运动功能的效果

doi:10.3969/j.issn.1006-9771.2022.02.003

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (2): 144-149.doi: 10.3969/j.issn.1006-9771.2022.02.003

骨科康复一体化模式对全膝关节置换术患者运动功能的效果

李冉^1a,²,杜巨豹^1a(),曹光磊^1b,李征^1b,李子怡^1a,葛亚丽^1a,钱龙^1a

1.首都医科大学宣武医院,a.康复医学科;b.骨科,北京市 100053
2.首都医科大学附属复兴医院康复中心,北京市 100038

收稿日期:2021-05-06 修回日期:2021-11-01 出版日期:2022-02-25 发布日期:2022-03-09
通讯作者: 杜巨豹 E-mail:dujubaofei@aliyun.com
作者简介:李冉(1987-),女,汉族,河南安阳县人,博士,主治医师,主要研究方向：膝关节置换术及骨折的骨科康复一体化,无创神经调控技术在脑功能康复中的应用。|杜巨豹,男,副主任医师。
基金资助:
北京市优秀人才青年骨干个人项目(2018000020124G141)

Effects of integrated orthopedic rehabilitation pathway on motor function after total knee arthroplasty

LI Ran^1a,²,DU Jubao^1a(),CAO Guanglei^1b,LI Zheng^1b,LI Ziyi^1a,GE Yali^1a,QIAN Long^1a

1. a. Department of Rehabilitation Medicine; b. Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
2. Rehabilitation Center, Fuxing Hospital, Capital Medical University, Beijing 100038, China

Received:2021-05-06 Revised:2021-11-01 Published:2022-02-25 Online:2022-03-09
Contact: DU Jubao E-mail:dujubaofei@aliyun.com
Supported by:
Beijing Excellent Talents Foundation(2018000020124G141)

摘要/Abstract

摘要：

目的研究骨科康复一体化模式下全膝关节置换术(TKA)患者在术后6个月内的疼痛、关节僵硬、关节活动度、肌力等运动功能的效果。方法选择2016年3月至2019年3月于首都医科大学宣武医院骨科接受TKA的180例患者的随访数据,收集年龄、性别、手术时间、门诊随访时间及术前、术后、术后1个月、术后3个月、术后6个月的特种外科医院膝关节评分(HSS-KS)和西部安大略和麦克马斯特大学骨关节炎指数评分(WOMAC),并重点关注肌力、关节活动范围、屈曲畸形、疼痛、僵硬、功能活动困难程度等子项目。结果共42例患者完成了术后3个月的随访,22例患者完成术后6个月的随访。HSS-KS、WOMAC评分在术前与术后比较无显著差异(P > 0.05)。术后3个月内HSS-KS评分逐步提高(P < 0.05),WOMAC评分逐步降低(P < 0.05)。其中,HSS-KS评分中的膝关节主动屈曲角度、伸膝肌力评分在术后减少(P < 0.05),术后1个月及术后个3月逐步恢复(P < 0.05);屈曲畸形评分在术后提高(P < 0.05),术后1个月下降(P < 0.05),术后3个月有提高趋势(P > 0.05)。WOMAC评分中的疼痛评分在术后3个月内持续下降(P < 0.05);僵硬评分在术后无改善(P > 0.05),术后1个月明显下降(P < 0.05),术后3个月无明显改善(P > 0.05);功能活动困难程度在术后增加(P < 0.05),之后持续降低(P < 0.05)。以上指标在术后6个月较术后3个月均无显著性差异(P > 0.05)。结论 TKA后3个月内的功能整体呈改善趋势,术后6个月时,功能仍维持在术后3个月水平。其中屈曲畸形评分在术后1个月有下降趋势,经及时加强康复指导后可再次改善,在术后康复中须给予特别关注。

关键词: 膝关节置换术, 骨科康复一体化, 运动, 疼痛, 屈曲畸形

Abstract:

Objective To study the effects of integrated orthopedic rehabilitation pathway on motor function in six months after total knee arthroplasty (TKA), including pain, stiffness, range of motion and muscle strength, etc. Methods From March, 2016 to March, 2019, 180 patients who underwent TKA and treated with integrated orthopedic rehabilitation pathway were enrolled. Age, gender, operation time, time of follow-up, the scores of Hospital for Special Surgery-Knee Scale (HSS-KS) and Western Ontario and McMaster Universities osteoarthritis index (WOMAC) at preoperative/postoperative/one-month after operation/three-month after operation/six-month after operation time points were collected. The sub items, such as muscle strength, range of motion, flexion deformity, pain, stiffness, functional difficulty were primarily focused on. Results A total of 42 patients were followed up for three months and 22 patients were followed up for six months. There was no significant difference in the scores of HSS-KS and WOMAC before and after operation (P > 0.05). Within three months after operation, the HSS-KS scores gradually increased (P < 0.05) and the WOMAC scores gradually decreased (P < 0.05). The active knee flexion range of motion and knee extensor muscle strength scores of HSS-KS significantly decreased after operation (P < 0.05), and gradually recovered one month and three months after operation (P < 0.05). The flexion deformity scores of HSS-KS increased after operation (P < 0.05), decreased one month after operation (P < 0.05), and got a trend of incensement again three months after operation. The pain score of WOMAC decreased continuously within three months after operation (P < 0.05); the stiffness score of WOMAC did not change after operation (P > 0.05), decreased significantly one month after operation (P < 0.05), and did not change three months after operation (P > 0.05). The degree of functional difficulty of WOMAC decreased after operation (P < 0.05), and improved continuously within six months after operation (P < 0.05). Conclusion The overall function after TKA shows a trend of improvement within three months, and there is no obvious improvement from three to six months after operation. The flexion deformity score showed a downward trend in one month after operation, and it could be improved again after strengthening rehabilitation, which needs more attention in the postoperative rehabilitation.

Key words: total knee arthroplasty, integrated orthopedic rehabilitation pathway, motion, pain, flexion deformity

中图分类号:

R687.4

李冉, 杜巨豹, 曹光磊, 李征, 李子怡, 葛亚丽, 钱龙. 骨科康复一体化模式对全膝关节置换术患者运动功能的效果[J]. 《中国康复理论与实践》, 2022, 28(2): 144-149.

LI Ran, DU Jubao, CAO Guanglei, LI Zheng, LI Ziyi, GE Yali, QIAN Long. Effects of integrated orthopedic rehabilitation pathway on motor function after total knee arthroplasty[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(2): 144-149.

图/表 2

表1

表2

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时间	n	HSS-KS评分	HSS-KS			WOMAC 评分	WOMAC
时间	n	HSS-KS评分	关节活动范围	肌力	屈曲畸形	WOMAC 评分	疼痛	僵硬	功能活动困难程度
术前	42	54.05±12.25	10.60±2.95	8.90±2.13	3.88±4.00	46.67±17.39	9.90±3.81	2.74±2.07	34.02±12.88
术后	42	54.76±12.67	9.36±3.23^a	6.71±3.05^a	6.83±3.63^a	53.29±12.64	7.21±4.09^a	3.17±1.75	42.93±9.49^a
术后1个月	42	68.29±11.11^a,b	11.69±2.25^a,b	9.24±1.32^b	5.98±3.74^a	29.57±12.73^a,b	4.33±2.90^a,b	1.83±1.32^a,b	23.38±10.57^a,b
术后3个月	42	78.43±8.14^c	12.19±2.00	9.86±0.52^c	6.98±3.18	22.29±10.67^c	2.48±2.38^c	1.50±1.57	18.31±9.63^c
F值		53.204	14.638	21.412	8.453	49.301	37.829	11.531	45.530
P值		< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001

时间	n	HSS-KS评分	HSS-KS			WOMAC 评分	WOMAC
时间	n	HSS-KS评分	关节活动范围	肌力	屈曲畸形	WOMAC 评分	疼痛	僵硬	功能活动困难程度
术前	22	51.32±12.08	9.86±2.88	9.00±2.12	2.73±4.00	43.32±17.18	8.86±3.45	2.59±1.76	31.86±13.02
术后	22	53.05±13.78	8.82±3.83	6.91±3.13^a	6.55±4.08^a	55.00±14.00^a	8.09±4.24	2.59±1.50	44.32±11.09^a
术后1个月	22	70.45±10.38^a,b	11.18±2.02^b	9.27±0.98^b	5.41±3.92^a	28.32±12.24^a,b	3.68±2.88^a,b	1.5±1.30^a,b	23.14±10.04^a,b
术后3个月	22	76.82±8.96^c	11.77±2.18	9.91±0.43^c	6.18±3.36	23.14±11.23	2.91±2.62	1.45±1.57	18.77±9.14
术后6个月	22	78.27±12.67	11.82±2.15	9.91±0.43	6.86±3.36	18.09±13.69	2.36±3.66	1.27±1.42	14.45±10.77
F值		32.285	7.146	12.304	6.086	30.450	18.098	6.368	29.205
P值		< 0.001	0.001	< 0.001	< 0.001	< 0.001	< 0.001	0.002	< 0.001

骨科康复一体化模式对全膝关节置换术患者运动功能的效果

Effects of integrated orthopedic rehabilitation pathway on motor function after total knee arthroplasty

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