髋、膝关节置换术后首次下床最佳时间研究

Study on best time of first off⁃bed exercise after hip and knee arthroplasty

目的:探讨髋、膝关节置换术后首次下床最佳时间。方法:于2020年2月1日—2020年7月30日对山东省某三级综合医院拟行髋、膝关节置换术的314例住院病人进行追踪观察,根据病人首次下床时间将其分为4组,观察1组(首次下床时间为术后12 h内)77例,观察2组(首次下床时间为术后12~24 h)84例,观察3组(首次下床时间为术后>24~48 h)82例,观察4组(首次下床时间为术后48 h后)71例。评价4组病人疼痛评分、尿潴留发生率、便秘发生率、深静脉血栓(DVT)发生率、患侧腿围增长情况、伤口愈合时间、住院时间、住院费用及关节周围感染、假体脱位、假体周围骨折发生率。结果:4组病人疼痛评分、尿潴留发生率、便秘发生率、DVT发生率、患侧腿围增长情况、住院时间、住院费用比较,差异均有统计学意义(P<0.05),且观察1组疼痛评分、尿潴留发生率及DVT发生率优于观察4组,便秘发生率、患侧腿围增长情况优于观察3组和观察4组,住院时间、住院费用优于观察2组、观察3组和观察4组(P<0.05)。结论:髋、膝关节置换病人首次下床较佳时间为术后12 h内。

Objective:To explore the best time of first off⁃bed exercise after hip and knee arthroplasty.Methods:From 1 February,2020 to 30 July,2020,314 inpatients in a tertiary general hospitals in Shandong who were going to undergo hip and knee arthroplasty were followed up and observed.The patients were divided into 4 groups according to the time of first off⁃bed exercise after hip and knee arthroplasty,77 patients were observed in group 1(the time of first off-bed exercise was within 12 hours after arthroplasty),84 patients were observed in group 2(the time of first off⁃bed exercise was from 12 hours to 24 hours after arthroplasty),and 82 patients were observed in group 3(the time of first off⁃bed exercise was more than 24 hours to 48 hours after arthroplasty).71 patients were observed in group 4(the time of first off⁃bed exercise was 48 hours after arthroplasty).The Numeric Rating Scales,the incidence of urinary retention,the incidence of constipation,the incidence of deep vein thrombosis(DVT),the condition of the lower limb swelling,the wound healing time,the length of hospital stay and hospitalization costs,the incidence of periprosthetic joint infection,the incidence of prosthesis dislocation,the incidence of periprosthetic fractures were evaluated.Results:There were statistically significant differences in scores of Numeric Rating Scales,incidence of urinary retention,incidence of constipation,incidence of DVT,the condition of the lower limb swelling,the length of hospital stay,and hospitalization cost among the 4 groups of patients(P<0.05).The scores of Numeric Rating Scales,the incidence of urinary retention and the incidence of DVT in group 1 were lower than those in group 4.The incidence of constipation,and the condition of the lower limb swelling in group 1 were lower than those in group 3 and group 4.The length of hospital stay and hospitalization costs in group 1 were lower than those of the group 2,group 3 and group 4(P<0.05).Conclusions:The better time of first off⁃bed exercise for hip and knee arthroplasty patients is within 12 hours after operation.