加速康复外科护理对关节镜下前交叉韧带重建术后患者膝关节功能的影响

Effects of enhanced recovery nursing after surgery on knee function among patients with anterior cruciate ligament reconstruction under arthroscope

目的探讨加速康复干预对关节镜下前交叉韧带(ACL)重建术后患者膝关节功能康复效果的影响。方法采用便利抽样法选择2013年1月—2016年4月四川大学华西医院骨科行关节镜下ACL重建术后患者120例,根据入院时间分为两组,对照组60例,行传统康复治疗;观察组60例,给予加速康复外科干预。比较两组患者术后关节肿胀、积液情况,使用Judet评分和lysholn评分比较两组膝关节屈曲及膝关节整体康复效果。结果观察组早期关节肿胀较对照组明显,术后行关节穿刺抽液12例,对照组有5例,但两组比较差异无统计学意义(χ^2=3.358,P=0.067);对照组6例术后出现膝关节屈曲功能障碍,经手法松解后关节功能达优。观察组术后3、6个月膝关节功能活动度达优率为83.33%、96.67%,优于对照组的58.33%、83.33%,两组比较差异有统计学意义(χ^2值分别为9.076、5.926;P<0.05)。观察组术后3个月、6个月膝关节功能评分达优率为80.00%、91.67%,高于对照组的56.67%、78.33%,两组比较差异有统计学意义(χ^2值分别为7.548、4.183;P<0.05)。结论关节镜下ACL重建术后患者实施加速康复外科干预,早期可能出现关节肿胀、积液等并发症,但能够有效改善膝关节早期功能和活动范围。

Objective To explore the effects of enhanced recovery after surgery( ERAS) intervention on functional rehabilitation among patients with anterior cruciate ligament( ACL) reconstruction under arthroscope. Methods From January 2013 to April 2016, we selected 120 patients with ACL reconstruction under arthroscope in Department of Orthopedics in West China Hospital of Sichuan University by convenience sampling. All of the patients were divided into two groups according to the admission time including control group( n=60, traditional rehabilitation) and observation group( n=60, ERAS intervention). We compared the ankle swelling, effusion and the knee flexion as well as knee rehabilitation effect of patients in two groups with the Judet score and the Lysholn score after surgery. Results The early ankle swelling of patients in observation group was more obvious than that in control group, and there were 12 cases with joint puncture drainage after surgery in observation group and 5 cases in control group with no statistical difference(χ^2=3.358, P=0.067). There were 6 cases with knee functional disorder after surgery in control group reaching the excellent knee function after manual release. The excellent rates of knee function activity in observation group were respectively 83.33% and 96.67% three and six months after surgery superior than those( 58.33% and 83.33%) in control group with statistical differences(χ^2=9.076, 5.926;P<0.05). The excellent rates of scores of knee function in observation group were respectively 80.00%, 91.67% three and six months after surgery higher than those( 56.67% and 78.33%) in control group with statistical differences(χ^2=7.548, 4.183;P < 0.05). Conclusions The application of ERAS intervention in ACL reconstruction under arthroscope can effectively improve early function and scope of activity of knee, however the complications may occur, such as ankle swelling and effusion.