术前预康复在老年膝关节置换合并肌少症患者中的应用

Application of preoperative pre-rehabilitation in elderly patients with knee arthroplasty combined with sarcopenia

目的探讨术前预康复在老年膝关节置换合并肌少症患者中的应用效果。方法采用便利抽样法纳入2020年7月—2021年12月在郑州大学第一附属医院骨科住院行人工膝关节置换术合并肌少症的164例老年患者,根据随机数字表法分为对照组和观察组,各82例。对照组采取常规术前护理,观察组在对照组的基础上实施术前预康复干预。干预前和术后1个月评价两组患者膝关节活动度、美国特种外科医院膝关节评分(HSS)、骨骼肌质量指数和握力,记录并比较两组住院时间和术后并发症情况。结果两组患者术后1个月的膝关节活动度、HSS均较干预前升高,且差异有统计学意义(P<0.05);术后1个月,观察组的膝关节活动度、HSS、握力均高于对照组,差异有统计学意义(P<0.05);观察组术后1个月的骨骼肌质量指数较干预前升高,但差异无统计学意义(P>0.05)。观察组患者的住院时间短于对照组,差异有统计学意义(P<0.05);观察组和对照组并发症总发生率分别为15.85%(13/82)、39.02%(32/82),差异有统计学意义(P<0.05)。结论术前预康复可以有效提高老年肌少症患者行膝关节置换术后的膝关节活动度和关节功能水平,缓解肌少症,且能缩短住院时间和减少术后并发症。

Objective To investigate the application effect of preoperative prerehabilitation in elderly patients with knee arthroplasty combined with sarcopenia.Methods A total of 164 elderly patients who were hospitalized and underwent artificial knee arthroplasty combined with sarcopenia in Department of Orthopedics of the First Affiliated Hospital of Zhengzhou University from July 2020 to December 2021 were included by the convenient sampling method.According to random number table method,they were divided into the control group and the observation group,with 82 cases in each group.The control group received routine preoperative nursing,and the observation group received preoperative pre-rehabilitation intervention on the basis of the control group.Knee range of motion,Hospital for Special Surgery Knee Score(HSS),skeletal muscle mass index and grip strength were evaluated before intervention and 1 month after operation.Length of stay and postoperative complications were recorded and compared between the two groups.Results Knee range of motion,HSS of two groups at 1 month after operation were higher than those before intervention,and the differences were statistically significant(P<0.05).One month after surgery,the knee range of motion,HSS and grip strength of the observation group were higher than those of the control group,and the differences were statistically significant(P<0.05).The skeletal muscle mass index of the observation group was higher one month after surgery than before intervention,but the difference was not statistically significant(P>0.05).The hospitalization time of observation group was shorter than control group,and the difference was statistically significant(P<0.05).The incidence of complications in the observation group and control group was respectively 15.85%(13/82)and 39.02%(32/82),and the difference was statistically significant(P<0.05).Conclusions Preoperative rehabilitation can effectively improve the knee range of motion and joint function of elderly patients with sarcopenia after knee rarthroplasty,alleviate sarcopenia,shorten the length of hospital stay and reduce postoperative complications.