规范化管理对全膝关节置换术后患者膝关节功能康复的影响

Clinical study of the effect of standardized management on knee functional rehabilitation after total knee arthroplasty

目的:探讨建立全膝关节置换术(Total knee arthroplasty,TKA)后规范化康复管理对患者康复效果的影响。方法:成立康复小组,分析TKA术后康复指标优秀率低的原因,建立三级督导体系,完善标准化康复路径,采用多元化健康教育方法,形成了一套规范化的TKA术后康复管理模式。选取2015年1月至2015年3月期间住院首次接受TKA的75例患者作为对照组,采用传统护理方法。选取2016年1月至2016年3月期间住院首次接受TKA的75例患者为观察组,采用规范化康复管理。通过美国膝关节协会(American knee society,AKS)评分观察患者术后1周、术后2周、术后1个月、术后3个月的康复指标情况,同时以问卷法调查患者对康复满意度及医生对康复满意度。结果:观察组患者在膝活动度、疼痛、行走能力、上下楼能力、总分、患者对康复满意度及医生对康复满意度得分均高于对照组,差异均有统计学意义(P<0.05),在膝稳定性上两组比较无统计学意义(P>0.05)。结论:通过对TKA患者康复锻炼的规范化管理与质量控制,可较大限度提高患者肢体康复效果,改善患者生活质量,提高医、护、患满意度,是一种科学的、有效的干预方法。

Objective： To investigate the effect of standardized rehabilitation management mode on functional rehabilitation after total knee arthroplasty（TKA）. Methods： Our department set up a rehabilitation group to analyze the reasons for the low recovery rate after TKA since April 2015. A standardized rehabilitation management mode after TKA was set up through establishing the three level supervision system, improving the standard recovery path and using diversified methods of health education. 75 patients who underwent first knee replacement from January 2015 to March 2015 were selected as the control group, and the traditional nursing mode was used. While 75 patients undergoing first knee replacement from January 2016 to March 2016 in our department were selected as standardized group, and the standardized rehabilitation management was used.American knee society（AKS）score was used to observe the rehabilitation indexes of patients at 1 week, 2 weeks, 1 month and3 months after operation. At the same time, the questionnaire was used to investigate the rehabilitation satisfaction degree of both patients and doctors. Results： The scores of patients in standardized group were significantly higher than that in control group in the knee mobility, pain, walking ability, ability to go up and down the stairs, the total scores as well as the rehabilitation satisfaction degree of both patients and doctors, and the differences were statistically significant（P〈0.05）. There was no statistical significance in knee stability.Conclusion： The standardized management and quality control of rehabilitation exercise in TKA patients is a scientific and effective intervention mode, which can help improving rehabilitation effect,improving the quality of life of patients, improving doctors, nursesand patients＇ satisfaction degree.