膝关节置换术后早期闭链功能锻炼的临床观察

发布时间：2018-06-13 03:08

本文选题：膝关节手术 + 膝关节骨性关节炎　；参考：《福建中医药大学》2017年硕士论文

【摘要】：目的:探讨膝关节表面置换术(Total Knee Arthroplasty,TKA)术后进行早期闭链式功能锻炼的临床意义。方法:前瞻性分析2015年11月至2016年10月于我院治疗并符合纳入标准的膝关节表面置换术术后患者60例。患者随机分为早期闭链功能锻炼组(试验组)30例和对照组30例。试验组术后即行踝泵运动、手术24h之后行屈膝屈髋锻炼、手术72h之后行直立屈膝功能锻炼、手术后1周行类似踩平衡板运动、手术3周之后行单腿直立屈曲锻炼。对照组患者手术即行踝泵运动,手术24h之后行直腿抬高锻炼、手术72h之后行压腿功能锻炼、手术1周之后行床边屈膝锻炼。对比试验组患者与对照组患者术前、术后1周、术后3周、术后6周及术后3个月的美国特种医院的评分系统(Hospital for Special Surgery,HSS)、术前及术后第2、3个月后视觉模拟评分(Visual Analogue Scale,VAS),统计两组患者并发症发生情况。结果:术前两组患者的年龄、性别、手术节段、体重指数、HSS、VAS评分无明显差异(P0.05)。所有患者均获得随访。试验组2名患者未按规定锻炼、对照组3名患者未按规定锻炼予以剔除。两组患者术后HSS评分与术前比均显著改善(P0.05),术后1周、术后3周、术后6周以及术后3个月试验组患者的HSS评分优于对照组(P0.05)。两组患者术后VAS评分与术前比均显著改善(P0.005),术后第2个月试验组患者VAS评分优于对照组(P0.05),而术后3个月两组患者间的HSS评分结果差异无统计学意义(P=0.353)。对照组1例患者出现切口愈合不良,予持续换药观察,对渗出做培养,并且做出相关处理后予以剔除,余患者术后均未发生下肢深静脉血栓、感染等并发症。结论:膝关节表面置换术术后患者进行早期闭链式功能锻练能促进其早期康复、提高疗效,并且是安全可行的。
[Abstract]:Objective: to investigate the clinical significance of early closed chain exercise after total knee arthroplasty. Methods: from November 2015 to October 2016, 60 patients who were treated in our hospital and met the standard of knee arthroplasty were analyzed prospectively. Patients were randomly divided into early closed chain function exercise group (30 cases in the experimental group and 30 cases in the control group). In the experimental group, ankle pump exercise was performed immediately after operation, knee flexion and hip flexion exercise was performed 24 hours after operation, orthostatic flexion function exercise was performed 72 hours after operation, similar balance plate exercise was performed 1 week after operation, and one leg upright flexion exercise was performed 3 weeks after operation. The patients in the control group underwent ankle pump exercise 24 hours after operation straight leg elevation exercise 72 hours after operation and knee bending exercise at the bedside after 1 week operation. The patients in the trial group were compared with those in the control group before operation, 1 week after operation and 3 weeks after operation. Six weeks after operation and three months after operation, the scoring system of for Special SurgeryHSS in American Special Hospitals was used. Visual Analogue scale and visual analogue scale were evaluated before and 2 and 3 months after operation. The complications of the two groups were calculated. Results: there was no significant difference in age, sex, operative segment, body mass index (BMI) and VAS score between the two groups (P 0.05). All patients were followed up. Two patients in the test group did not exercise as required, and three patients in the control group were excluded. The HSS scores of the two groups were significantly improved than those of the control group. The HSS scores in the trial group were significantly better than those in the control group at 1 week, 3 weeks, 6 weeks and 3 months after operation. The VAS scores in the two groups were significantly improved compared with those before operation (P 0.005). The VAS scores in the test group were better than those in the control group (P 0.05) at the 2nd month after operation, but there was no significant difference in HSS score between the two groups at 3 months after operation. In the control group, one patient had bad wound healing and was observed by continuous dressing change. The exudation was cultured and removed after treatment. No complications such as deep vein thrombosis and infection occurred in the remaining patients after operation. Conclusion: it is safe and feasible for the patients after knee surface replacement to carry out early closed chain exercise to promote their early recovery and improve the curative effect.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.6

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