全膝关节置换术后持续被动训练与主动功能锻炼对患者快速康复效果的影响

目的 评估全膝关节置换术后持续被动训练与主动功能锻炼对患者加速康复效果的影响。方法 回顾性分析自2019-01—2021-12完成的80例全膝关节置换术,根据术后患者康复训练完成情况分组。A组40例依从性较差,无法规范进行主动功能锻炼,仅在持续被动训练机上进行功能训练。B组40例规范完成持续被动训练与主动功能锻炼。比较两组术后住院时间、肌间静脉血栓发生率、术后第1周疼痛VAS评分,以及术后膝关节主动活动度、膝关节功能HSS评分、患肢膝关节周径。结果 80例术后切口一期愈合,未出现切口裂开或切口感染。B组住院时间较A组缩短,术后第1周疼痛VAS评分、住院期间肌间静脉血栓发生率低于A组,术后第3天、术后1周、术后4周膝关节主动活动度、膝关节功能HSS评分明显高于A组,术后第3天、术后1周、术后4周患肢膝关节周径小于A组,差异有统计学意义（P<0.05）。结论 全膝关节置换术后患者在临床医师和康复医师指导下进行膝关节主动功能训练与持续被动训练更有利于快速康复,改善膝关节功能,减少膝关节功能障碍发生。     

疼痛护理在人工全膝关节置换术后康复锻炼中的应用体会

目的探讨疼痛护理在人工全膝关节置换术后康复锻炼中的应用体会。方法对67例人工全膝关节置换术后的进行疼痛、康复训练等护理措施。结果术后随访6~18个月,膝关节屈膝活动活动范围较术前明显提升,采用HSS膝关节评分标准,优良率95.52%(64/67)。结论有效疼痛护理可以提高人工全膝关节置换术后康复锻炼的有效率和人工全膝关节的成功率。     

高屈曲度膝关节假体置换术后患者功能锻炼方法的探讨

目的：探讨改良锻炼方法在高屈曲度膝关节假体置换术后的应用效果。方法：将100例行高屈曲度膝关节假体置换术的患者随机分为对照组和改良组各50例。对照组予常规功能锻炼；改良组术后使用镇痛药和肌松药，并按自行设计的膝踝屈伸、并膝下蹲及屈膝锻炼等方法循序渐进进行功能锻炼。结果：术后不同时间对照组与改良组膝关节功能评分及膝关节活动度比较，差异有显著性意义（均P〈0．01）。结论：关节置换术后应尽早进行功能锻炼，而改良锻炼法对于提高高屈曲度膝关节假体置换术后关节活动度和关节功能具有较好的促进作用。     

程序化康复锻炼对全膝关节置换术后关节功能恢复的影响

目的：探讨程序化康复指导对全膝关节置换术后关节功能恢复的影响。方法：选取2012年1月～2013年1月在我科行全膝关节置换的患者530例,按照康复程序由专人每天监督患者进行相应的康复训练项目进行训练。结果：所选530例全膝关节置换患者出院时膝关节屈曲度均大于90。。结论：程序化康复锻炼对膝关节置换术后关节功能的恢复效果显著。     

全膝关节置换术后患者早期持续被动运动状况调查

目的 了解全膝关节置换术后患者早期持续被动运动康复锻炼的现况,为临床护理提供参考.方法 采用方便抽样法对60例住院全膝置换术患者进行持续被动运动康复锻炼问卷调查,问卷内容包括心理、生理、认知功能状况和康复主动参与性4个方面,于患者进行持续被动运动期间进行调查.结果 51.7%的患者在开始阶段存在心理问题;患者在锻炼不同阶段的疼痛、酸胀不适感发生率比较,差异有统计学意义(均P＜0.01),是影响其接受持续被动运动的主要因素;在不同阶段患者对持续被动运动的认知程度差异有统计学意义(P＜0.01);80%患者表示可接受持续被动运动.结论 全膝关节置换术后早期持续被动运动患者,在锻炼不同阶段存在不适感和心理问题.护士应根据各阶段患者需要进行心理疏导和健康教育,从而提高全膝关节置换术后患者持续被动运动的依从性.     

全膝关节置换术的康复锻炼

采用人工膝关节置换(TKR)对疾病或肿瘤造成的关节破坏进行修复，解决疼痛，畸形和功能障碍，重建一个接近正常功能的关节，是近年矫形外科中发展最快的领域之一。随着全膝关节置换术的广泛应用，术后康复日益受到重视，良好的康复活动，可以最大限度地改善假体关节功能。我院自1999年3月至2003年3月共行全膝关节置换9例，均施行了科学规范的康复锻炼，效果满意。     

全膝关节置换术病人的康复护理

对40例全膝关节置换术病人按照预定的康复计划进行术前教育、早期功能锻炼,术后6 h即开始进行膝关节锻炼,术后3 d鼓励病人下地活动。结果术后2周病人的关节平均活动度达到90°,HSS评分为82分。提示术前、术后护理及早期功能锻炼安全可行,可促进关节功能早期恢复,并可有效预防并发症。     

高屈曲度膝关节假体置换术后患者功能锻炼方法的探讨

目的 探讨改良锻炼方法在高屈曲度膝关节假体置换术后的应用效果.方法 将100例行高屈曲度膝关节假体置换术的患者随机分为对照组和改良组各50例.对照组予常规功能锻炼;改良组术后使用镇痛药和肌松药,并按自行设计的膝踝屈伸、并膝下蹲及屈膝锻炼等方法循序渐进进行功能锻炼.结果 术后不同时间对照组与改良组膝关节功能评分及膝关节活动度比较,差异有显著性意义(均P＜0.01).结论 关节置换术后应尽早进行功能锻炼,而改良锻炼法对于提高高屈曲度膝关节假体置换术后关节活动度和关节功能具有较好的促进作用.     

人工全膝关节置换术的康复锻炼

我科自1997年10月-2002年11月行人工膝关节置换11例，在实践中我们体会到正确的患肢功能锻炼是手术取得满意效果的重要条件之一。     

全膝关节置换术功能锻炼支架的研制与应用

目的探究全膝关节置换术患者有效的功能锻炼技术。方法将60例实施全膝关节置换术的老年患者随机分为观察组和对照组各30例,对照组采用常规功能锻炼方法,观察组采用自制膝关节功能锻炼支架进行锻炼。结果观察组患膝关节屈曲角度、行走距离显著优于对照组,疼痛程度显著轻于对照组(均P<0.05)。结论膝关节功能锻炼支架可提升全膝关节置换手术患者功能锻炼效果,减轻患者锻炼疼痛。     

功能锻炼决策辅助对单侧全膝关节置换恐动症患者的影响

目的 探讨决策辅助对单侧全膝关节置换恐动症患者术后功能锻炼依从性的影响.方法 按照住院时间将单侧全膝关节置换术后恐动症患者143例分为对照组72例和干预组71例.对照组给予常规治疗和护理,干预组在循证基础上,通过专家会议,构建并实施功能锻炼决策辅助方案.比较两组患者出院时、术后1个月和3个月功能锻炼依从性、恐动症和膝关...     

全膝关节置换术后早期功能康复

目的　探讨全膝关节置换术后进行早期功能康复的方法和时机。方法　２３ 例（３４ 膝） 骨水泥全膝关节置换术后患者按照预定的康复计划进行早期功能锻炼。术后６ ｈ 内即开始进行膝关节ＣＰＭ 锻炼,２４ ｈ 下地站立。术后引流血予以回输。结果　术后２ 周平均关节活动度达９０°,ＨＳＳ评分平均７１ 分。３ 例出现切口局部皮缘灶性坏死延期愈合,无其它并发症。结论　术后早期功能锻炼安全可行,可使关节功能早期恢复,并可有效预防并发症。     

Continuous-flow cold therapy after total knee arthroplasty

Cryotherapy is widely used as an emergency treatment of sports trauma and postoperatively especially after anterior cruciate ligament reconstruction. Studies in the literature on the effect of cryotherapy after total knee arthroplasty (TKA) have been limited and controversial. In this prospective study, 60 primary TKAs were done on 30 patients (all staged bilateral TKAs). For every patient, 1 TKA had a continuous-flow cooling device applied over the surgical dressing immediately postoperatively. The other TKA in the same patient (control TKA) was done 6 weeks later and had no cooling device. The study compared the range of motion, the volume of hemovac output and blood loss, visual analog pain score, analgesic consumption, and wound healing in the 2 limbs of the same patient. This study showed that continuous-flow cold therapy is advantageous after TKA because it provides better results in all the areas compared.     

Predictors of multidimensional functional outcomes after total knee arthroplasty

Multiple assessments are used clinically after total knee arthroplasty (TKA) including self‐report, performance tasks, and physical activity levels. It is unclear if these different functional assessments are interchangeable or if they measure different constructs. The objective of this study was to characterize different functional measures before and after TKA. We characterized function before and after TKA using perceived function (KOOS ADL), physical performance (gait speed), and daily activity (steps/day via accelerometry); compared function in people undergoing TKA to age‐matched healthy controls; and examined characteristics of those undergoing TKA for potential predictors of postoperative function. Prior to TKA, all three functional assessments were significantly lower for participants than those of healthy controls and each measure remained lower for participants than for controls postoperatively. All three functional assessments developed differently over time postoperatively. Each functional outcome had a unique set of predictors. Perceived function was predicted primarily by anxiety and depression, physical performance was most strongly predicted by age, and daily activity was chiefly predicted by BMI. Pressure pain threshold was a common predictor across all models. Functional limitations exist preoperatively and persist postoperatively across different measures in people undergoing TKA when compared to those measures in healthy controls. Functional outcomes after TKA are different depending on the functional measure utilized, implying that different constructs underlie each measure. Multiple functional measures should be assessed to provide a more comprehensive assessment of function after TKA. Further work should assess the impact of interventions designed to treat modifiable predictors of postoperative TKA function. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2790–2798, 2017.

     

全膝置换术后早期功能锻炼应用健康教育互动模式

目的探讨健康教育互动模式对全膝置换术后患者早期膝关节功能锻炼及功能恢复的影响。 方法选取2016年1月至2016年12月的西安交通大学第二附属医院骨科113例住院行全膝关节置换术患者,使用随机数字对照法分为实验组59例和对照组54例。实验组在医护全程诊疗模式的基础上成立健康教育互动模式小组,制定人工全膝关节置换术系统性、规范化术后早期功能锻炼护理路径表并按路径表实施一对一互动功能锻炼指导。对照组则采用传统健康宣教方法。应用t检验分别比较两组患者在术前、术后3、7、14 d的特种外科医院(HSS)评分。 结果通过健康互动模式制定早期功能锻炼路径计划表在人工全膝置换术后早期功能锻炼中的应用,使用HSS膝关节功能评分表对两组患者的术前、术后3 d、术后7 d及术后14 d的患肢功能锻炼效果进行评价,实验组患者的HSS评分在术后优于对照组(术后3 d t＝0.67,术后7 d t＝4.78,术后14 d t＝3.63,均为P<0.05)。 结论健康教育互动模式在全膝置换术后早期功能锻炼中应用,提高了患者进行术后锻炼的依从性,促进了膝关节功能的恢复,提高了患者的生活质量。     

全膝关节置换治疗膝关节炎术后早期镇痛的研究进展

因膝关节炎而行全膝关节置换术的患者在术后早期多会出现程度不一的疼痛,这直接影响术后膝关节早期的功能锻炼及康复。目前,常用的镇痛方法有静脉自控镇痛、硬膜外自控镇痛、连续股神经阻滞镇痛、关节周围注射药物镇痛以及一些非药物性镇痛等。本文对全膝关节置换术后早期镇痛方法研究进展进行综述。     

Maximizing patient satisfaction and functional results after total knee arthroplasty

The purpose of this article is to review the issues regarding preoperative patient expectations for total knee arthroplasty and whether or not these are fulfilled after surgery. The demographics of the typical total knee arthroplasty patient are changing, and the expectations regarding the outcome of the surgery have been changing as well. Patients are younger, heavier, more active, and often come to the surgeon's office with information provided via the Internet that may be inaccurate and/or misleading. Many expect and assume that the operation will return the knee to "normal." Traditional outcomes measures used by orthopedic surgeons to determine the quality of the results achieved are inadequate and do not take into account the higher expectations of current patients. Various strategies have been developed to improve satisfaction after the surgery. These include preoperative patient education, less invasive surgical approaches, advances in prosthetic design, multimodal pain management, and aggressive postoperative rehabilitation. Using these strategies will make preoperative expectations more realistic and improve postoperative satisfaction.     

Exercise improves early functional recovery after total hip arthroplasty

The purpose of this prospective, randomized study was to apply an 8-week customized exercise program to patients (Group E) scheduled for total hip arthroplasty, followed by a postsurgery exercise program, and show the effect on functional recovery compared with control subjects (Group C) who received no additional exercise apart from routine in-hospital physical therapy. Strength, range of motion, and physical function tests were completed by 57 patients at Week 8 and Week 1 before surgery and at Weeks 3, 12, and 24 postoperatively. No differences between the exercise and control groups were observed at baseline. By 1 week before surgery, patients in Group E had shown significant improvements for Western Ontario and McMaster Universities Osteoarthritis Index (total score, stiffness, and physical function components), and combined hip strength. Patients in Group E had improved hip flexion range of motion in the diseased hip compared with patients in Group C. Significant differences in outcome measures between Group E and Group C were observed throughout the postoperative phase from Weeks 3 to 24. The current study showed that customized perioperative exercise programs are well tolerated by patients with end-stage hip arthritis, and are effective in improving early recovery of physical function after total hip arthroplasty.     

Osteolysis after total knee arthroplasty

Osteolysis ranks as the most significant cause of revision surgery in both total hip arthroplasty and total knee arthroplasty (TKA). The factors leading to osteolysis in TKA are unique and sometimes preventable. Changes in polyethylene manufacturing and implant design are striving to improve overall wear. In this review, we discuss osteolysis as it relates to TKAs. The etiology, diagnosis, contributing factors, and management are presented. The final section focuses on future improvements in TKA design, which may ultimately decrease the rate of osteolysis.