早期阶段性康复干预对老年膝关节骨性关节炎患者全关节置换术后下肢疼痛及功能的影响

目的:测试阶段性康复干预方案在缓解TKR术后膝关节疼痛和改善膝关节主体功能方面的安全性和可行性,并评估测量身体功能的变化。方法:本研究共纳入了46例受试者,被随机分进对照组和康复干预组。对照组(n=22)接受关节置换术后临床常规治疗和康复指导;康复干预组(n=24)在接受临床常规治疗同时,将在术后第一天开始接受每天1次(第1阶段)或每周3次(第2、3阶段),为期12周的"全膝关节置换术后康复干预方案"。所有患者在术前、术后4周、术后12周接受全身状态、疼痛及膝关节相关功能评估。结果:在干预组,患者在术后第4—12周,下肢功能逐步得到显著改善,减轻疼痛表现为WOMAC、VAS、肌力、主被动ROM、患肢维度、BBS、FAC、FIM评分与术前存在显著性差异(P<0.05)。与对照组相比,干预组患者的疼痛和功能恢复速度更快、幅度更大。术前、术后VAS疼痛评分与病程、BMI、WOMAC呈显著正相关(P<0.05),与伸膝肌力、主动ROM、BBS、FIM、FAC呈显著负相关(P<0.05)。结论:持续12周的分阶段TKR术后康复方案,对改善TKR术后患者的疼痛缓解和功能恢复有明显效果,其训练计划是安全可行的。疼痛控制是康复干预关键因素。

Effects of early stage rehabilitation intervention on the pain and function of lower limb after total joint replacement in elderly patients with knee OA

Objective:To test the safety and feasibility of phased rehabilitation intervention in alleviating knee joint pain and improving knee joint function after TKR,and to evaluate the changes of body function.Method:A total of 46 subjects were enrolled in this study and were randomized into control and rehabilitation intervention groups.The control group(n=22)received routine clinical treatment after arthroplasty.From the first postoperative day,the rehabilitation intervention group(n=24)received routine clinical treatment and a 12-weeks rehabilitation intervention program after total knee arthroplasty once a day(stage 1)or 3 times a week(stages 2 and 3).All patients underwent assessment of general condition,pain,and knee function preoperative,postoperative 4 weeks,and postoperative 12 weeks.Result:In the intervention group,the function and pain of lower extremities gradually improved from the 4th week to the 12th week after operation.The scores of WOMAC,VAS,muscle strength,active and passive ROM,limb dimension,BBS,FAC and FIM score all showed a statistically significant difference from preoperation(P<0.05).Compared with the control group,the patients in the intervention group showed faster pain alleviation and function recovery with greater magnitude.Preoperative and postoperative VAS pain scores were positively correlated with duration of disease,BMI and WOMAC(P<0.05),and negatively correlated with muscle strength,active ROM,BBS,FIM and FAC(P<0.05).Conclusion:The staged TKR postoperative rehabilitation program for 12 weeks has obvious effect on the pain relief and functional recovery after TKR.The training plan is safe and feasible.Pain control is a key factor in the rehabilitation interventions.