全膝关节置换术后系统康复的疗效评价

目的评估全膝关节置换术后系统康复和短期康复对膝关节功能恢复有无差异。方法回顾2006年3月至2010年11月我科单侧全膝关节置换病例，选择骨性关节炎行单侧全膝关节置换术病例48例，所有患者均接受相同骨科常规治疗、护理和康复指导。按照拆线后康复治疗方式将其分为系统康复组（术后由专科医生指导康复，疗程45d以上）和对照组（出院后给予书面康复指导，自行康复治疗）。两组康复治疗内容包括术前指导、肌力训练、关节活动度训练、平衡功能及本体感觉、步态和日常活动能力训练。于手术治疗前1d，手术后第14天及第45天进行膝关节功能评分（HSS）以及膝关节关节活动范围（ROM）。结果术后第14天时，全膝关节置换术后患者HSS评分和ROM均较术前明显改善（P〈0．01），但两组之间差异无统计学意义（P〉0．05）。术后第45天时，系统康复组HSS评分和ROM改善较对照组好（P〈0．05）。结论全膝关节置换能够有效地改善骨性关节炎膝关节功能；术后经系统康复训练的膝关节功能恢复效果较好。

Evaluation of outcomes on long-term standard rehabilitation following total knee replacement

Objective To discuss the effects of long-term standard rehabilitation following total knee replacement （TKR）. Methods Forty-eight cases of unilateral total knee replacement during March 2006 to November 2010 were retrospec tively analyzed and randomly divided into long-term standard rehabilitation group（receiving a guidance by a rehabilitation spe- cialist after surgery for more than 45 days） and control group （receiving a written rehabilitation guidance after discharge from hospital at home）. All patients received the same routine orthopedic treatment, care and rehabilitation guidance. The rehabili- tation procedure consisted of preoperative guidance, intensive training, range of motion training, balance and proprioceptive function, gait and activities of daily living training. Patients were evaluated at the 1st day before and the 14th and 45th day after operation. The evaluation indexes involved the Hospital for Si3ecial Surgery Knee Score （HSS） and knee range of motion （ROM）. Results At the 14th day after operation, HSS and ROM in two groups were significantly improved （P~0. 111 ）, and there was no significant difference between the two groups （P~0. 05）. At the 45th day after operation, HSS and ROM in long-term standard rehabilitation group were better than in control group （P〈0. 05）. Conclusion Total knee replacement can effectively improve osteoarthritis knee function. Long-term standard rehabilitation can facilitate function restoration.