全膝关节置换术后的康复治疗要点与相关研究

康复治疗对人工膝关节置换术后的临床效果至关重要，是术后膝关节功能能够达到预期效果的重要措施。肌力训练、关节活动度训练、本体觉训练及行走步态训练是术后康复治疗最重要的内容。为最大限度地恢复膝关节功能，综合康复训练必不可少，包括各种主动肌力训练增加膝关节伸、屈肌力；早期持续被动膝关节活动度训练增加关节活动度；本体感觉训练改善膝关节的运动控制能力、姿势校正及平衡维持能力；行走步态训练矫正异常行走步态等。     

全膝关节置换术后的康复干预

背景：随着人工关节材料的改进和假体设计的不断完善、全膝关节置换技术的不断成熟，以全膝关节置换术治疗严重类风湿性关节炎和骨性关节炎已能取得良好的结果。目前国内外普遍认为全膝关节置换术后尽早进行分阶段的循序渐进的康复治疗可促进患者膝关节功能恢复，达到生活自理。从而提高生活质量。 目的：阐述全膝关节置换术后的康复治疗及其相关研究。 资料来源：应用计算机检索Medline数据库1998-01／2005—08的相关文章，检索词“total knee replacement。Rehabilitation，therapy”，限定文章语言种类为英文。同时计算机检索中国期刊全文数据库、万方数据库1990-01／2004-12的相关文章。检索词“全膝关节置换术；康复；治疗”，限定文章语言种类为中文。 资料选择：对资料进行初审，纳入标准：①关于全膝关节置换术后康复治疗的项目、步骤、过程及注意事项。②对具体病例的回顾调查研究。排除标准：排除重复性研究。 资料提炼：共收集到符合上述要求的文献37篇。排除22篇重复性研究。15篇符合纳入标准：其中3篇关于全膝关节置换术及有关康复治疗的综述。8篇关于全膝关节置换术后康复治疗的临床研究。4篇关于全膝关节置换术后康复治疗相关因素的分析研究。另参阅了有关专著3本。 资料综合：康复治疗对人工膝关节置换术后的临床效果至关重要，是术后膝关节功能能够达到预期效果的重要原因。肌力训练、关节活动度训练、本体觉训练及行走步态训练是术后康复治疗最重要的内容。为最大限度的恢复膝关节功能。综合的康复训练必不可少：包括各种主动肌力训练增加膝关节伸、屈肌力；早期持续被动的膝关节活动度训练增加关节活动度；本体感觉训练改善膝关节的运动控制能力、姿势校正及平衡维持能力；行走步态训练矫正异常行走步态。 结论：全膝关节置换术后尽早进行分阶段的循序渐进的康复治疗，即对患者进行肌力训练、关节活动度训练、本体觉训练及行走步态训练。对提高手术疗效、促进患者膝关节功能恢复有着重要的作用。     

全膝关节置换术后的康复干预

背景:随着人工关节材料的改进和假体设计的不断完善、全膝关节置换技术的不断成熟,以全膝关节置换术治疗严重类风湿性关节炎和骨性关节炎已能取得良好的结果。目前国内外普遍认为全膝关节置换术后尽早进行分阶段的循序渐进的康复治疗可促进患者膝关节功能恢复,达到生活自理,从而提高生活质量。目的:阐述全膝关节置换术后的康复治疗及其相关研究。资料来源:应用计算机检索Medline数据库1998-01/2005-08的相关文章,检索词“totalkneereplacement,Rehabilitation,therapy”,限定文章语言种类为英文。同时计算机检索中国期刊全文数据库、万方数据库1990-01/2004-12的相关文章,检索词“全膝关节置换术;康复;治疗”,限定文章语言种类为中文。资料选择:对资料进行初审,纳入标准:①关于全膝关节置换术后康复治疗的项目、步骤、过程及注意事项。②对具体病例的回顾调查研究。排除标准:排除重复性研究。资料提炼:共收集到符合上述要求的文献37篇,排除22篇重复性研究。15篇符合纳入标准:其中3篇关于全膝关节置换术及有关康复治疗的综述,8篇关于全膝关节置换术后康复治疗的临床研究,4篇关于全膝关节置换术后康复治疗相关因素的分析研究。另参阅了有关专著3本。资料综合:康复治疗对人工膝关节置换术后的临床效果至关重要,是术后膝关节功能能够达到预期效果的重要原因。肌力训练、关节活动度训练、本体觉训练及行走步态训练是术后康复治疗最重要的内容。为最大限度的恢复膝关节功能,综合的康复训练必不可少:包括各种主动肌力训练增加膝关节伸、屈肌力;早期持续被动的膝关节活动度训练增加关节活动度;本体感觉训练改善膝关节的运动控制能力、姿势校正及平衡维持能力;行走步态训练矫正异常行走步态。结论:全膝关节置换术后尽早进行分阶段的循序渐进的康复治疗,即对患者进行肌力训练、关节活动度训练、本体觉训练及行走步态训练,对提高手术疗效、促进患者膝关节功能恢复有着重要的作用。     

人工膝关节置换与围手术期系统康复

目的:探讨围手术期系统康复对人工膝关节置换术后效果的影响.方法:收集中国期刊全文数据库1996-01/2006-12及PUBMED1996-01/2006-12有关人工膝关节置换围手术期系统康复的文献,对系统关节功能训练方法及其对人工膝关节置换手术效果的影响进行综合分析.结果:术前教育、关节活动度训练、肌力训练、本体感觉训练及行走步态训练是人工膝关节置换术围手术期系统康复的最重要的内容.人工膝关节置换术患者经过系统规范的围手术期康复治疗:其术后膝关节的关节活动度、下肢肌肉力量、行走时的步态及本体感觉等诸多方面均能够在短时间内恢复正常.结论:人工膝关节置换围手术期系统康复治疗对于手术后的临床效果至关重要,是术后膝关节功能达到预期效果的重要措施.     

人工全膝关节置换术后的早期康复

目的人工全膝关节置换术后进行康复活动,在于防止粘连,增加关节活动度和肌力,减少畸形,提高日常生活能力。方法我们制订了一整套的人工全膝关节置换术后的康复常规。自１９９６年在我院试用于２４例人工全膝关节置换术后患者（３５膝）,获得良好的早期临床效果。结果术后２０天,患者安静及行走时疼痛、行走距离、转移能力、肌力及屈曲畸形较术前明显改善,差异有显著性;拐杖的使用率及内外翻畸形较术前明显下降,差异有显著性;关节的稳定性较术前无明显差异;但关节的活动度较术前下降,差异有显著性;使用楼梯能力较术前无明显改善。结论全膝关节置换术后患者出院后仍须继续进行正确的肌力、关节活动度及日常生活能力的康复训练。     

人工膝关节置换者康复治疗的特征

目的:分析人工全膝关节置换后康复的影响因素,探讨康复治疗的实施方法.方法:以人工膝关节,置换,康复为检索词,检索中国期刊全文数据库(1999-01/2009-06);以artificial knee joint, athroplasty,rehabilitation为检索词,索PubMed数据库(1999-01/2009-06),文献检索语种限制为中文和英文.以膝关节的活动度,关节功能,肌力,关节稳定性为评价指标.纳入人工膝关节置换后康复治疗的临床研究,排除动物实验.结果:计算机初检得到492篇文献,根据纳入排除标准,对人工膝关节置换后康复的临床研究进行分析.人工全膝关节置换后康复训练的主要内容包括疼痛的处理、关节活动度训练、肌力训练、本体感觉训练及行走功能训练.膝关节活动度是评价人工全膝关节置换疗效的重要指标之一,也是大多数膝评分系统中的一个重要组成部分.患者疼痛症状的改善和是否恢复正常行走功能是观察人工全膝关节置换后疗效的重要指标.肌力训练被认为是置换后康复最重要的部分,尽早进行训练不但可以使患者的膝周肌力尽早得以恢复,还可以促进下肢血液循环,预防深静脉血栓形成.结论:通过康复能尽快恢复患者的肌力、关节活动度和行走能力,同时最大程度控制疼痛.置换后康复活动是否得当,成为直接影响置换效果好坏的重要因素.     

早期护理干预对全膝关节置换术后功能恢复的影响

目的观察人工全膝关节置换术（TKR）患者进行早期护理干预康复训练的效果。方法选择TKR患者30例39个膝关节，入院后行系统化早期护理干预康复指训练方案：即肌力锻练、活动度训练、平衡功能训练。结果采用美国特种外科医院（HSS）膝关节评分标准，术后经调查表示优21例，良9例，优良率98％。结论TKR术后早期护理干预康复指导能减少膝关节并发症，提高患者的生活质量。     

全膝关节置换术后早期康复的疗效

目的：探讨全膝关节置换术后早期进行康复功能训练的方法和时机。方法：23例（34膝）膝关节疾病患者均行全膝关节置换术,术前即给予系统的康复指导,术后6h内进行踝关节活动、股四头肌静力性收缩、CPM锻炼。结果：术后20d患者可独立行走,其行走的距离、转移能力、肌力、屈曲、畸形、内外翻均较术前明显好转;HSS评分比治疗前显著提高（72、32,P〈0.01）。结论：全膝关节置换术后早期康复功能训练安全可行,可使关节功能早期恢复。     

运动疗法对膝关节置换术后关节功能恢复的效果

目的:探讨主动运动和被动运动对人工全膝关节置换(TKA)术后2周膝关节功能恢复的效果。方法:选择我院2014年12月~2015年4月收治的60例骨性关节炎患者,将患者随机等分为主动运动组和被动运动组,主动运动组康复锻炼采用踝泵训练、股四头肌收缩训练、直腿抬高训练、弯腿训练、屈膝训练、站立行走训练及上下台阶训练。被动运动组行CPM机辅助训练,CPM机角度从30°开始,之后每天增加10°,伸膝屈膝完成一个动作45 s,每次30 min,每天2次。采用美国膝关节外科学会评定标准(KSS),对两组患者人工膝关节置换术后康复训练2周膝关节功能进行临床疗效评定。结果:主动运动组人工全膝置换术后2周膝关节的活动度、膝关节伸膝、屈膝肌群的肌力、膝关节稳定性改善程度优于被动运动组,两组比较差异有统计学意义(P0.05)。结论:主动运动更有利于患者膝关节活动度、膝关节伸肌、屈肌肌群的肌力、膝关节稳定性改善。     

46例类风湿性关节炎病人行双侧人工全膝关节置换术后的康复护理

[目的]总结类风湿性关节炎病人行双侧人工全膝关节置换术后的康复护理。[方法]对46例类风湿性关节炎病人行双侧人工全膝关节置换术,同时加强术后心理护理、一般护理、康复训练等。[结果]46例病人切口均获一期愈合,局部疼痛减轻或消失,至术后2周拆线时膝关节活动度达到70°～100°,平均80°;随访8周至62个月,采用美国特种外科医院膝关节评分(HSS)评定膝关节功能,优26例,良14例,中6例;均能弃拐自行行走,能满足基本日常生活需要。[结论]加强类风湿性关节炎病人行双侧人工全膝关节置换术后的康复护理,有助于术后膝关节功能的恢复。     

运动疗法的进展与差距

运动疗法是防治心、脑、肺疾病的重要方法之一,同时对这些疾病的危险因素(高血压、高脂血症、糖尿病和肥胖)也有确切的治疗作用。本文介绍了国内康复医学界运动疗法的进展与先进国家的差距以及对其改进提高和完善的一些设想。     

Potassium and ventilation during positive and negative work inpatients with chronic obstructive pulmonary disease

In patients with chronic obstructive pulmonary disease (COPD),reduced ventilatory reserves limit exercise tolerance. In these patients, the ventilatoryrequirements of eccentric exercise (negative work, W_neg) are lower thanthose of concentric exercise (positive work, W_pos) at similar workloads.In this study, we investigated the relationship between plasma potassium levels and ventilationduring W_pos and W_neg in these patients. Twelvepatients with stable COPD [mean (SD) FEV₁ 46% (16) of predicted]performed W_pos and W_neg on a cycle ergometer(6 min of exercise; interval ≥1 h) in a randomized order at a constant workload of50% of the individual maximum (positive) work capacity. Minute ventilation (V_E) and arterial plasma potassium concentration ([K⁺]_a) were measured at rest, and at 1-min intervals during exercise and during 3 min ofrecovery. V_E increased less during W_neg thanduring W_pos [6 (range 3–26) vs. 18 (range 8–28) l min^?1; P<0·01]. V_E during W_neg was reduced in proportion to VCO ₂.The increase in [K⁺]_a during W_pos and W_neg [0·45 (range 0·26–0·75) and0·34 (range 0·1–0·97) mM ] did not differsignificantly. V_E was closely correlated with VCO ₂ during both types of exercise. V_E was also closelycorrelated with [K⁺]_a, but the slope of the relationship between[K⁺]_a and V_E was steeper during W_pos than during W_neg [39·1 (range15·2–88·6) vs. 18·3 (range7·2–37·3) l min^?1 mM ^?1; P=0·012]. In contrast, the slope of the relationship betweenVCO ₂ and V_E was similar during bothtypes of exercise [27?8 (range 19·2–37·1) vs. 32·1 (range19·8–48·4)]. Thus, for a given increase in [K⁺]_a, the increase in V_E was significantly less during W_neg. In patients with COPD, potassium did not explain the difference inexercise ventilation between W_neg and W_pos, andmay not play a significant role in the control of breathing during low-intensity exercise.     

A Meta-Analytic Review of the Hypoalgesic Effects of Exercise

The purpose of this article was to examine the effects of acute exercise on pain perception in healthy adults and adults with chronic pain using meta-analytic techniques. Specifically, studies using a repeated measures design to examine the effect of acute isometric, aerobic, or dynamic resistance exercise on pain threshold and pain intensity measures were included in this meta-analysis. The results suggest that all 3 types of exercise reduce perception of experimentally induced pain in healthy participants, with effects ranging from small to large depending on pain induction method and exercise protocol. In healthy participants, the mean effect size for aerobic exercise was moderate (d_thr = .41, d_int = .59), while the mean effect sizes for isometric exercise (d_thr = 1.02, d_int = .72) and dynamic resistance exercise (d_thr = .83, d_int = .75) were large. In chronic pain populations, the magnitude and direction of the effect sizes were highly variable for aerobic and isometric exercise and appeared to depend on the chronic pain condition being studied as well as the intensity of the exercise. While trends could be identified, the optimal dose of exercise that is needed to produce hypoalgesia could not be systematically determined with the amount of data available.     

Tired of being inactive: a systematic literature review of physical activity,physiological exercise capacity and muscle strength in patients with chronic fatigue syndrome

A systematic review was undertaken to examine whether patients with chronic fatigue syndrome (CFS) differ from healthy sedentary controls in physiological exercise capacity, physical activity level and muscle strength. From the available literature, it can be concluded that patients with CFS perform less physical activity during daily life, and have less peak isometric muscle strength compared to healthy sedentary control subjects. Conflicting data in relation to physiological exercise capacity of patients with CFS have been reported, but the weighted available evidence points towards a reduced physiological exercise capacity in CFS. Future studies should use a wash-out period for medication use, blinded assessments, a priori power calculation and a sedentary control group comparable for age, gender, body weight, body length and current physical activity level.     

Exercise-related thoughts in cardiac exercise programs: A study of exercise-adherent cardiac rehabilitation patients

Exercise plays an important preventive and rehabilitative role in coronary heart disease. Unfortunately, cardiac rehabilitation exercise programs have high drop out rates. Several studies with noncardiac patients indicate that exercise-related strategies engaged in during exercise play an important role in exercise performance and adherence. We assessed exercise-related cognitions utilized by a group of cardiac rehabilitation patients who were adherent to a structured exercise program. Thirty-six subjects provided information on their cardiac history and exercise patterns and reported on the thoughts that they might have when exercising in situations depicted in 11 vignettes. Responses, rated using a reliable coding scheme, revealed that the majority of thoughts involved evaluating progress relative to goals and engaging in motivational self-talk. Other strategies reported included using cognitive distraction, thinking about body shape and arousal, making comparisons between self and others, and engaging in social distraction and interaction. Findings suggest that the exercise adherent subjects in this study use specific cognitive and behavioral strategies. Future studies comparing exercise thoughts of both adherent and nonadherent persons and prospective evaluation of their relationships to exercise adherence appear warranted.     

脑卒中偏瘫患者心肺运动功能评估临床研究

目的:评估脑卒中后偏瘫患者心肺运动功能,了解偏瘫患者心肺功能储备能力,探寻脑卒中偏瘫患者有氧运动康复方案。方法:选取11例脑卒中后偏瘫患者(实验组)和11例健康志愿者(对照组)进行心肺运动实验测试,比较两组受试对象心肺运动实验各指标差异。结果:两组受试对象性别、年龄、体重指数等基础指标差异无显著性。实验组峰值摄氧量(13.1±3.2 vs 22.3±6.6ml/kg/min)、无氧阈(11.2±2.9 vs 15.5±3.6ml/kg/min)、能量代谢当量(3.7±0.9 vs 6.4±1.9)、峰值氧脉搏(7.7±2.0 vs11.2±2.5ml)、峰值呼吸交换率(0.98±0.08 vs 1.15±0.11)、峰值分钟通气量(30.9±8.5 vs 55.7±17.7L/min)、峰值功率(72.5±18.8 vs 118.8±46.8w)与最大心率(117.9±14.7 vs 135.1±20.4bpm)明显低于对照组(P0.05),静息心率(81.6±11.5 vs 72.5±4.9bpm)明显高于对照组(P0.05)。实验组静息血压与峰值血压与对照组比较无显著性差异(P0.05)。结论:脑卒中偏瘫患者心肺运动功能明显低于健康人,心肺储备功能下降,脑卒中偏瘫患者的康复过程中有必要给予一定强度的有氧运动,以改善心肺运动功能,预防卒中再发和提高运动功能。     

轻中度哮喘患者与健康人的运动耐量对比研究

目的 :比较轻中度哮喘患者与健康人的运动心肺功能 ,研究运动对哮喘患者肺功能的影响 ,探讨轻中度哮喘患者提高运动耐量的可行性。方法 :采用负荷递增运动方案 ,对 2 0例轻中度哮喘患者及 2 0例健康志愿者进行了运动心肺功能试验。运动前后测一秒钟用力呼气容积 (FEV1 )、用力肺活量 (FVC)、最大呼气中段流量 (FEF 2 5 %- 75 % )、最大呼气末段流量 (FEF 75 % - 85 % )、呼气流量峰值 (PEF)等 ,运动中监测心率 (HR)、每分钟氧耗量(VO2 )、每分钟二氧化碳排出量 (VCO2 )、每分钟通气量 (VE)、氧脉搏 (O2 pulse)、呼吸频率 (BF)等。结果 :运动后 ,哮喘组与正常对照组的FVC、FEV1 、PEF、FEF 2 5 %— 75 %、FEF 75 %— 85 %均有所改善 ,有统计学意义 (P <0 .0 5) ,但两组在改善的差值上无显著意义 (P >0 .0 5)。哮喘患者的最大作功、最大氧耗量 (VO2max)、最大二氧化碳排出量 (VCO2max)、最大每分钟通气量 (VEmax)均显著低于健康人 (P <0 .0 5) ,无氧阈提前出现。结论 :轻中度哮喘患者的运动能力低于健康人 ,但通过小负荷运动可改善肺功能     

有氧运动结合抗阻练习对缺乏运动中年人体质健康的影响

目的:探讨有氧运动结合抗阻练习对中年人各方面身体能力的影响。方法:募集上海某区无专业运动经验,40~60岁的89名受试者,分为A组(每周运动次数3次)和B组(每周运动次数≥3次)。在8周运动干预前后进行11项体质测试,包括体脂率、骨密度等。干预期间不进行饮食监控,也无强制性集中运动。结果:运动干预8周后,2组男、女性体重和BMI与干预前比较差异无统计学意义;B组体脂率较干预前及A组下降明显(P0.05)。男性B组握力、伸膝肌力、坐位体前屈及闭眼单脚站立时间均较干预前明显增加(P0.05),且伸膝肌力较A组明显增加(P0.05);女性B组伸膝肌力、坐位体前屈及闭眼单脚站立时间均较干预前明显增加(P0.05),且坐位体前屈较A组明显增加(P0.05)。男、女性B组最大摄氧量及女性B组骨密度均较A组显著提高(P0.05)。A组各项指标干预前后比较均差异无统计学意义。结论:长期坚持规律性的运动锻炼,有助于中年人降低体脂率;改善身体素质,增强上下肢肌力,提高有氧能力和维持正常骨密度水平。     

Exercise limitations and training for patients with cystic fibrosis

Summary

Exercise has much to offer to cystic fibrosis patients. Overcoming the limits of decreased pulmonary function by increasing fitness has a considerable potential to improve patients' quality of life; decreased breathlessness allows greater mobility and participation with peers in social and sporting activities, improves confidence and self-esteem and creates a greater pleasure in life for the individual patient. There are also immediate therapeutic gains and potentially long-term gains with improved survival. Above all, cystic fibrosis patients enjoy and prefer exercise as a therapeutic option to most other forms of therapy.