目的 评价远程康复对全膝关节置换术后疼痛控制和功能恢复等方面的影响。 方法 检索CNKI、万方数据库、中国生物医学文献数据库(CBM)、维普信息资源系统(VIP)、PubMed、Web of Science、Medline、Springer Link和Cochrane Library等9个数据库，收集2000年至2018年发表的远程康复对全膝关节置换术后患者影响的中英文随机对照试验(RCT)。由2名研究者进行文献筛选、质量评价、资料提取和数据分析。选取西安大略和麦克马斯特大学骨关节炎指数(WOMAC)、关节屈曲度和伸展度、计时起立-行走测试(TUGT)、视觉模拟评分法(VAS)、膝关节损伤及骨性关节炎转归评分(KOOS)和肌力等作为结局指标。 结果 共纳入6项RCT研究，共601例，其中干预组301例，对照组300例。Meta分析显示，两组在关节伸展度(MD = 0.30, 95%CI: 0.20~0.40, P < 0.001)、TUGT评分(MD = -5.17, 95%CI: -9.79~-0.55, P = 0.03)、VAS评分(MD = -0.43, 95%CI: -0.85~-0.01, P = 0.04)和KOOS评分(MD = -1.10, 95%CI: -1.63~0.57, P < 0.0001)方面差异有统计学意义，但在WOMAC评分(MD = -0.32, 95%CI: -2.30~1.65, P = 0.75)、关节屈曲度(MD = 0.68, 95%CI: -2.28~3.63, P = 0.65)和肌力(MD = 13.77, 95%CI: -3.89~31.43, P = 0.13)方面差异无统计学意义。 结论 远程康复可加大关节伸展度，增强步行能力，缓解疼痛，提高生活质量，但在关节屈曲度、关节功能和肌力方面效果尚不能确定。
Objective To evaluate the outcome of telerehabilitation in pain control and function recovery after total knee arthroplasty. Methods CNKI, Wanfang Data (WF), CBM, VIP, PubMed, Web of Science, Medline, Springer Link, and Cochrane Library were searched on the effects of telerehabilitation on the patients after total knee arthroplasty, and the literatures of random control trials (RCT) study in English and Chinese in the above databases from 2000 to 2018 were collected. Literature screening, quality evaluation, data extraction and data analysis were carried out by 2 researchers. The indexes of outcome in the RCT studies included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), extension and flexion range, the Timed Up and Go Test (TUGT), Visual Analogue Scale (VAS) and Knee Injury and Osteoarthritis Outcome Score (KOOS). Results A total of 6 RCT studies were included, with a total of 601 cases, 301 in the intervention group and 300 in the control group. There was difference in extension range (MD = 0.30, 95%CI: 0.20 to 0.40, P < 0.001), TUGT scores (MD = -5.17, 95%CI: -9.79 to -0.55, P = 0.03), VAS scores (MD = -0.43, 95%CI: -0.85 to -0.01, P = 0.04) and KOOS scores (MD = -1.10, 95%CI: -1.63 to 0.57, P < 0.0001) between two groups. There was no significant difference in WOMAC scores (MD = -0.32, 95%CI: -2.30 to 1.65, P = 0.75), flexion range (MD = 0.68, 95%CI: -2.28 to 3.63, P = 0.65), and muscle strength (MD = 13.77, 95%CI: -3.89 to 31.43, P = 0.13) (P > 0.05) between two groups. Conclusion Telerehabilitation is effective to improve extension range, ambulation, pain and quality of life, while it is uncertainly effective in flexion range, knee function and muscle strength.
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