全膝关节置换术后短期膝关节功能及其影响因素

doi:10.3969/j.issn.1006-9771.2024.01.015

《中国康复理论与实践》 ›› 2024, Vol. 30 ›› Issue (1): 111-118.doi: 10.3969/j.issn.1006-9771.2024.01.015

全膝关节置换术后短期膝关节功能及其影响因素

王子豪¹, 李昕华^2a, 蒋慧萍^2b, 郭赛男^2b, 梁秋曼³, 史婷奇^2b()

1.南京中医药大学鼓楼临床医学院，江苏南京市 210008
2.南京大学医学院附属鼓楼医院，a.运动医学与成人重建外科；b.护理部，江苏南京市 210008
3.南京中医药大学护理学院，江苏南京市 210023

收稿日期:2023-10-11 修回日期:2023-12-20 出版日期:2024-01-25 发布日期:2024-02-04
通讯作者: 史婷奇(1975-)，女，汉族，江苏徐州市人，副教授，主任护师，硕士研究生导师，主要研究方向：护理管理、医院信息化建设与管理。E-mail：13912996998@163.com
作者简介:王子豪(1995-)，男，汉族，江苏苏州市人，硕士研究生，护师，主要研究方向：康复护理。
基金资助:
1.南京大学中国医院改革发展研究院课题(NDYG2022067);2.南京市卫生科技发展专项资金项目(YKK22074)

Short-term knee function after total knee arthroplasty and related factors

WANG Zihao¹, LI Xinhua^2a, JIANG Huiping^2b, GUO Sainan^2b, LIANG Qiuman³, SHI Tingqi^2b()

1. Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210008, China
2. a. Division of Sports Medicine and Adult Reconstructive Surgery; b. Department of Nursing, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, China
3. School of Nursing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, China

Received:2023-10-11 Revised:2023-12-20 Published:2024-01-25 Online:2024-02-04
Contact: SHI Tingqi, E-mail: 13912996998@163.com
Supported by:
Nanjing University China Hospital Reform and Development Research Institute Project(NDYG2022067);Nanjing Health Science and Technology Development Special Fund Project(YKK22074)

摘要/Abstract

摘要：

目的调查患者全膝关节置换术出院后短期膝关节功能状况，分析其影响因素。

方法采用便利抽样法，2022年12月至2023年4月，将在南京大学医学院附属鼓楼医院行全膝关节置换术即将出院的患者140例作为调查对象。基于文献回顾选定潜在的影响因素，出院前采用一般资料调查表、康复锻炼依从性量表、康复锻炼自我效能量表(SER)、疼痛视觉模拟量表(VAS)、关节活动度进行调查，出院后1个月采用美国特种外科医院膝关节评分(HSS)进行评定。

结果共随访130例。患者出院后1个月HSS评分40~82分，平均(70.89±6.26)分。多元线性回归分析显示，体质量指数(B = -0.423, 95%CI -0.622~-0.224, P < 0.001)及出院前VAS(B = -1.016, 95%CI -1.198~-0.113, P = 0.028)、康复锻炼依从性(B = 0.267, 95%CI 0.121~0.413, P < 0.001)、SER(B = 0.478, 95%CI 0.315~0.642, P < 0.001)、膝关节屈曲挛缩角度(B = -0.251, 95%CI -0.414~-0.088, P = 0.003)可影响患者在出院后1个月HSS评分(R²= 0.615, F =17.106, P < 0.001)。

结论全膝关节置换术患者在出院后短期膝关节功能恢复基本良好，但仍有很大上升空间，临床医护人员需针对其影响因素设计并实施相应的干预措施，提高患者术后短期功能。

关键词: 全膝关节置换术, 关节功能, 短期康复, 康复现状, 影响因素

Abstract:

Objective To investigate the short-term knee function recovery of patients undergoing total knee arthroplasty (TKA) after discharge and analyze its related factors.

Methods From December, 2022 to April, 2023, 140 adult patients who underwent TKA in Nanjing Drum Tower Hospital and being about to be discharged were selected as the survey subjects using convenient sampling. Potential influencing factors were selected based on a literature review. They were investigated with general information questionnaire, Rehabilitation Exercise Compliance Scale, Self-Efficacy Scale for Rehabilitation Exercise (SER), Visual Analog Scale for pain (VAS), and joint range of motion measurements before discharge, and were investigated with the Hospital for Special Surgery Knee Score (HSS) one month after discharge.

Results A total of 130 patients finished follow-up. One month after discharge, the HSS score ranged from 40 to 82, with an average of (70.89±6.26). Multiple linear regression analysis revealed that Body Mass Index (B = -0.423, 95%CI -0.622 to -0.224, P< 0.001), pre-discharge VAS (B = -1.016, 95%CI -1.198 to -0.113, P= 0.028), rehabilitation exercise compliance (B = 0.267, 95%CI 0.121 to 0.413, P< 0.001), SER (B = 0.478, 95%CI 0.315 to 0.642, P< 0.001), and knee joint flexion contracture angle (B = -0.251, 95%CI -0.414 to -0.088, P= 0.003) could influence HSS score one month after discharge (R² = 0.615, F=17.106, P< 0.001).

Conclusion Patients after TKA have recovered well in short time after discharge, however, there is still significant room for improvement. Clinical healthcare providers should design and implement appropriate interventions based on related factors to improve the function.

Key words: total knee arthroplastyt, joint function, short-term rehabilitation, rehabilitation status, related factors

中图分类号:

R684

王子豪, 李昕华, 蒋慧萍, 郭赛男, 梁秋曼, 史婷奇. 全膝关节置换术后短期膝关节功能及其影响因素[J]. 《中国康复理论与实践》, 2024, 30(1): 111-118.

WANG Zihao, LI Xinhua, JIANG Huiping, GUO Sainan, LIANG Qiuman, SHI Tingqi. Short-term knee function after total knee arthroplasty and related factors[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 111-118.

图/表 3

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表2

表3

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项目		n	HSS评分	F值/t值	P值
年龄	< 65岁	30	69.04±1.45	1.681	0.180
	65~69岁	40	71.82±0.98
	70~74岁	42	70.98±0.87
	≥ 75岁	18	72.78±1.17
性别	男	24	71.43±5.26	0.314	0.754
	女	106	70.98±6.46
文化程度	初中及以下	113	70.42±6.47	-2.230	0.028
	初中以上(中专、高中、大学)	17	74.00±3.29
住宅类型	平房	64	69.52±6.41	5.599	0.005
	楼梯房	30	70.47±6.56
	电梯房	36	73.69±4.79
主要照顾者	配偶	55	70.24±7.39	0.614	0.543
	子女	70	71.46±5.21
	其他	5	70.20±6.72
人均月收入	< 3000元	50	68.70±7.12	6.571	0.002
	3000~5000元	69	71.86±5.43
	> 5000元	11	74.82±2.93
并发症	0个	43	70.26±5.51	1.004	0.393
	1个	65	71.26±6.99
	2个	17	69.94±5.31
	3个及以上	5	74.80±4.66
疼痛年限	< 5年	40	70.60±7.02	0.275	0.760
	5~10年	65	70.75±6.14
	> 10年	25	71.72±5.39
手术时长	< 90 min	23	71.43±5.67	4.101	0.019
	90~120 min	76	71.84±4.90
	> 120 min	31	68.16±8.63
术后住院时间	≤ 3 d	74	69.88±6.98	-2.153	0.033
	> 3 d	56	72.23±4.91
术中出血量	< 100 mL	90	71.30±5.55	0.930	0.397
	100~200 mL	35	70.97±7.98
	> 200 mL	5	67.40±5.13

因素	r值	P值
VAS评分	-0.346	< 0.001
BMI	-0.208	0.018
康复锻炼依从性	0.513	< 0.001
SER评分	0.652	< 0.001
屈曲角度	0.230	0.009
屈曲挛缩角度	-0.238	0.006

因素	B	SE	β	t值	P值	95%CI
文化程度	0.641	1.151	0.035	0.557	0.579	-1.639~2.921
住宅类型	0.254	0.458	0.035	0.550	0.580	-0.652~1.160
人均月收入	0.615	0.652	0.061	0.944	0.347	-0.675~1.906
手术时长	-0.015	0.016	-0.054	-0.929	0.355	-0.048~0.017
术后住院时间	0.188	0.341	0.032	0.551	0.583	-0.488~0.864
BMI	-0.423	0.100	-0.252	-4.213	< 0.001	-0.622~-0.224
VAS评分	-1.016	0.456	-0.152	-2.228	0.028	-1.198~-0.113
康复锻炼依从性	0.267	0.074	0.240	3.623	< 0.001	0.121~0.413
SER评分	0.478	0.082	0.505	5.807	< 0.001	0.315~0.642
屈曲角度	-0.019	0.036	-0.035	-0.542	0.589	-0.090~0.052
屈曲挛缩角度	-0.251	0.082	-0.184	-3.043	0.003	-0.414~-0.088

全膝关节置换术后短期膝关节功能及其影响因素

Short-term knee function after total knee arthroplasty and related factors

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