医护技一体化加速康复模式促进前交叉韧带重建术后早期功能康复

Integrated enhanced rehabilitation model promotes early functional rehabilitation after anterior cruciate ligament reconstruction

目的探讨医护技一体化加速康复综合管理模式对膝关节前交叉韧带(ACL)损伤后患者康复影响的安全性及有效性。方法 2014年9月到2015年6月期间因外伤导致急性ACL损伤在四川大学华西医院运动医学科就诊,经关节镜检确认需行ACL重建手术的120例患者被纳入本研究。膝关节多发韧带损伤、合并骨性损伤、慢性ACL损伤等情况不予纳入。患者被随机分为实验组(60人)和对照组(60人)。实验组采用一体化加速康复措施,对照组采用传统围手术期管理模式。比较两组患者一般情况,术前术后膝关节活动度(ROM)及Lysholm评分,ROM恢复到90°及120°所需时间,SF-36生存质量评分。随访至术后12个月。计量资料采用(x珋±s)表示,组间比较采用t检验,计数资料采用率表示,两组比较采用2检验或Fisher检验。结果共111例患者完成随访,实验组54例,对照组57例。两组患者在年龄、性别比例、身体质量指数BMI、术前Lysholm评分等方面差异无统计学意义。实验组并发症发生更少(14. 8%vs 27. 3%,2=8. 33,P <0. 01)。与对照组相比,术后2周、1月及3月实验组膝关节ROM更大[(73±17)°vs (51±23)°,t=5. 64,P <0. 01;(94±23)°vs (78±25)°,t=3. 51,P <0. 01;(130±18)°vs (118±21)°,t=3. 23,P <0. 01]、Lysholm评分更高(t=3. 29,P <0. 01;t=2. 69,P=0. 01; t=5. 23,P <0. 01)。实验组膝关节ROM达到90°及120°所需时间均短于对照组[90°,(23±4) d vs (35±4) d,t=15. 53,P <0. 01; 120°,(37±15) d vs (54±13) d,t=6. 16,P <0. 01]。术后3月,实验组SF-36各项评分均高于对照组(PF,t=3. 55,P <0. 01; RP,t=5. 88,P <0. 01; BP,t=2. 86,P=0. 01; GH,t=2. 07,P=0. 04; VT,t=2. 86,P <0. 01; SF,t=2. 69,P <0. 01; RE,t=2. 29,P=0. 02; MH,t=2. 42,P=0. 01)。结论医护技一体化加速康复模式能够加快ACL损伤患者的术后早期功能康复,减少术后并发症发生,缩短住院时间,提高患者早期生存质量。

Objective To explore the safety and efficacy of comprehensive management model of enhanced rehabilitation for patients with acute anterior cruciate ligament(ACL)injury after knee injury.Methods From September 2014 to June 2015 120 patients with acute ACL injury due to trauma in sports medicine clinic of West China Hospital of Sichuan University,who were confirmed by arthroscopy and needed ACL reconstruction were included in this study.The patients who combined with multiple knee ligament injuries,bone injury,or chronic ACL injury were excluded.The patients were randomly assigned to the experimental group(60 pateints)and the control group(60 patients).The experimental group were treated with the combination steps of enhanced rehabilitation.The control group took the traditional perioperative management model.The general conditions,the preoperative and postoperative knee range of motion(ROM)and Lysholm score,the rehabilitation time for ROM of 90°and 120°,short form-36(SF-36)quality of life score were all compared between the two groups.These patients were followed up to 12 months after the surgery.The measurement data were expressed as(±s),and t-test was used for comparison between groups.The count data were expressed as ratio,and the two groups were compared using 2 test or Fisher test.Results A total of 111 patients were followed up,54 in the experimental group and 57 in the control group.There was no statistically significant difference in age,sex ratio,body mass index(BMI),or preoperative Lysholm score.Compared with the control group,the experimental group showed the fewer complications(14.8%vs 27.3%,2=8.33,P<0.01);better ROM[(73±17)°vs.(51±23)°,t=5.64,P<0.01;(94±23)°vs.(78±25)°,t=3.51,P<0.01;(130±18)°vs.(118±21)°,t=3.23,P<0.01]and higher Lysholm score(t=3.29,P<0.01;t=2.69,P=0.01;t=5.23,P<0.01)in two weeks,one month and three months postoperatively.The time required for the knee ROM reaching 90°and 120°was shorter in the experimental group than that in the control group[90°,(23±4)vs(35±4),t=15.53,P<0.01;120°,(37±15)vs(54±13),t=6.16,P<0.01].The levels of SF-36 in the experimental group were higher than those in the control group(PF,t=3.55,P<0.01;RP,t=5.88,P<0.01;BP,t=2.86,P=0.01;GH,t=2.07,P=0.04;VT,t=2.86,P<0.01;SF,t=2.69,P<0.01;RE,t=2.29,P=0.02;MH,t=2.42,P=0.01).Conclusion The comprehensive management model of enhanced rehabilitation technology could accelerate the early postoperative functional rehabilitation,reduce postoperative complications,shorten the length of stay and improve the quality of life in the acute ACL injure patients.