肥胖患者膝关节表面置换术后的早期康复

目的探讨肥胖患者初次膝关节置换术后早期康复的方法。方法自2009年1月至2012年6月共完成肥胖患者初次膝关节置换42例42膝，男8例，女34例；年龄60～78岁，平均65岁，身体质量指数（BMI）33—52，平均46。术后早期进行持续被动关节运动增加关节活动度（ROM）和进行股四头肌及胭绳肌肌力的强化训练，延长住院时间至术后14d。分别以术前2d、术后2d、1、2、4、8、12、24周作为观察点，使用VAS疼痛评分、WOMAC评分和ROM对膝关节功能及疼痛程度进行评价。结果术后VAS疼痛评分、WOMAC评分低于术前，术后ROM高于术前，差异均有统计学意义。所有指标在术后4周以后均有逐步改善，但差异没有统计学意义。结论肥胖患者膝关节置换术后早期行功能锻炼及适当延长住院时间可以提高膝关节功能。

Early rehabilitation of obese patients after total knee arthroplasty

Objective To investigate the methods of early rehabilitation of the obese patients after total knee arthroplasty （TKA）. Methods From January 2009 to June 2012, 42 patients （42 knees） were reviewed in the study, including eight males and 34 females, with an average age of 65 years （60 to 78 years）. The average body mass index （BMI） was 46, ranging from 33 to 52. The continuous passive motion and the muscle strength training of four quadriceps and hamstrings were enhanced in early stage and the length of hospital stay increased to 14 days after the surgery. The knee functions and the pain were evaluated using VAS, WOMAC scores and ROM two days before the surgery and on the 2nd day after the surgery, as well as in the 1^st, 2nd, 4^th, 8^th, 12^th and 24^th weeks postoperatively. Results The average postoperative WOMAC and VAS scores were significantly lower than the preoperative ones, while the postoperative knee ROM scored higher than the preoperative ones. The differences were significant （P 〈 0.05 ）. All of the indices were improved since the 4th week postoperatively but the differences between the four groups were not significant （P 〉 0. 05 ）. Conclusion The knee function can be improved by the postoperative rehabilitation protocols in the early stage and increasing the length of hospital stay of the obese patients after TKA.