骨科康复一体化模式对全膝关节置换术后功能恢复影响的临床研究

目的:评价骨科康复一体化治疗模式运用于全膝关节置换术对膝关节疼痛、功能及生存质量的改善效果,比较其与常规治疗模式干预的康复疗效差异。方法:将2014年5月—2015年3月前来解放军总医院第一附属医院关节外科就诊,第一诊断为膝关节骨性关节炎且初次行全膝关节置换术的患者94例,按就诊顺序随机分为观察组(47例)和对照组(47例),观察组给予骨科康复一体化治疗模式干预,对照组给予常规治疗模式干预,分别于术前和术后1周、4周、12周、24周采用膝关节主动关节活动度(active range of motion,AROM),数字疼痛评分(numeric rating scale,NRS)、HSS膝关节功能评分,以及生活质量量表(MOS 12-item short form health survey,SF-12)评价康复疗效。结果:术前两组患者膝关节AROM、NRS、HSS膝关节功能评分、SF-12量表中的心理总得分(physical component summary,MCS)和生理总得分(mental component summary,PCS)无差异(P0.05);术后1、4周时观察组膝关节AROM、SF-12量表中MCS均优于对照组(P0.05),但NRS两组无差异(P0.05);术后1周时膝关节HSS评分、SF-12量表中的PCS组间比较无差异(P0.05);术后4周时观察组的膝关节HSS评分、SF-12量表中的生理总得分(PCS)均优于对照组(P0.05);术后12周及24周时观察组AROM、NRS、HSS膝关节功能评分及SF-12量表中的PCS、MCS均明显优于对照组(P0.05)。结论:对初次行全膝关节置换术的患者进行骨科康复一体化治疗模式干预后的康复疗效确切,其对改善膝关节功能、患者的心理功能以及缓解疼痛的康复疗效优于常规的治疗模式且显著提高患者的生活质量。

Effectiveness of integrated rehabilitation approach and orthopaedic treatment on functional recovery after total knee arthroplasty

Abstract Objective: To evaluate the effectiveness of integrated rehabilitation approach and orthopedic treatment on functional recovery, pain relieve and the quality of life improvement after total knee arthroplasty, and to compare rehabilitation efficacy with conventional treatment modality.Method: From May 2014 to March 2015, 94 patients,whose first diagnosis was knee osteoarthritis,underwent primary total knee arthroplasty in the Department of Joint Surgery of the First Affiliated Hospital of People''s Liberation Army General Hospital. The patients were randomly divided into two groups according to the doctor order,the observation group and the control group, with 47 cases in each group. The observation group was treated with integrated rehabilitation approach and orthopaedic treatment,while the control group with conventional treatment modality. The rehabilitation effects of the two groups were evaluated respectively at 1 week, 4 weeks, 12 weeks, 24 weeks after operation using AROM, NRS, HSS knee functional score and SF-12.Result: There are no significant differences between two groups in the distribution of AROM, NRS ,HSS knee functional score and PCS, MCS of SF-12 before surgery (P>0.05). AROM and MCS of SF-12 of the observation group were slightly better than that of the control group in postoperative 1 and 4 weeks (P<0.05), but NRS revealed no significant difference between two groups in pain relief (P>0.05). HSS knee functional score and PCS of SF-12 also showed no significant difference between two groups in postoperative 1 weeks (P>0.05), but they were better than that of the control group in postoperative 4 weeks (P<0.05). The AROM, NRS,HSS knee functional score and MCS,PCS of SF-12 of the observation group were better than that of the control group in postoperative 12 and 24 weeks (P<0.05). Conclusion: The rehabilitation effects were efficient for patients who had been given integrated rehabilitation approach and orthopaedic treatment after primary total knee arthroplasty, with better rehabilitation effects in improving knee, mental function and relieving pain compared with conventional treatment modality. And it can significantly improve the quality of life of patients.