骨科康复一体化模式下膝关节单髁置换术后1年内膝关节功能康复转归的临床研究

Effects of integrated orthopaedic rehabilitation on the outcome of motor function in patients with unicom⁃partmental knee arthroplasty within one year after surgery

目的:研究膝关节单髁置换术后1年内患者膝关节功能康复转归,发现可能阻碍患者膝关节快速康复的功能障碍。方法:纳入2016年1月至2019年8月在宣武医院骨科康复一体化模式下首次进行膝关节单髁置换的243例(256膝)患者,分别在术前、术后、术后1个月、术后3个月、术后6个月、术后1年,记录患者的美国特种外科医院膝关节评分(hospital for special surgery-knee scale,HSS-KS)及西部安大略和麦克马斯特大学骨关节炎指数评分(western Ontario and Mc Master Universities osteoarthritis index,WOMAC),关注膝关节肌力、屈曲畸形、活动度、功能活动、疼痛、僵硬、功能活动困难程度。采用单因素重复测量方差分析比较其在术前及术后1年内的膝关节功能康复转归。结果:完成术后3个月、6个月、12个月随访的病例数为94、60、39。HSS-KS总分术后有降低趋势,活动度及功能评分在术后显著降低,三者术后1至6个月持续增加;肌力评分术后有降低趋势,术后1个月恢复术前水平,僵硬评分术后有降低趋势,术后1个月较术后显著降低,屈曲畸形评分术后显著提高,之后三者改善不明显;WOMAC总分术前术后无显著差异,疼痛评分术后显著降低,活动困难评分术后显著升高,三者术后1—6个月持续降低,所有观察指标在术后1年较术后6个月无显著差异。结论:膝关节单髁置换术后6个月内的功能整体呈改善趋势,术后6—12个月无明显改善。如何更快地改善膝关节疼痛、活动度和功能活动需给予关注。

Objective:To trace the outcomes of motor function rehabilitation in one year after unicompartmental knee arthroplasty,and to find out the dysfunction that may hinder rapid rehabilitation.Method:A total of 243 patients with 256 knees who underwent unicompartmental knee arthroplasty for the first time under the integrated mode of orthopaedic rehabilitation in Xuanwu Hospital from January 2016 to August 2019 were retrospectively enrolled.Age,gender,operation time,time of follow-up,HSS-KS&WOMAC score at preoperation/1-month after operation/3-month after operation/6-month after operation/12-month after operation were collected.The subitem of muscle strength,range of motion,flexion deformity,functional activities,pain,stiffness,functional difficulty were primarily focused on.Repeated measurement ANOVA was used to compare the rehabilitation outcome of motor function before and within 12 months after operation.Result:The number of patients followed up at 3 months,6 months and 12 months were 94,60 and 39.HSS-KS total score had a decreasing trend after surgery,activity and functional score decreased significantly after surgery,and the three continued to increase from 1 to 6 months after surgery.Muscle strength score showed a decreasing trend after operation,and recovered to the preoperative level 1 month after operation.Stiffness score showed a decreasing trend after operation,and decreased significantly 1 month after operation,while flexion deformity score increased significantly after operation.There was no significant difference in the total WOMAC score before and after surgery,the pain score decreased significantly after surgery,and the mobility difficulty score increased significantly after surgery.The three scores continued to decrease from 1 to 6 months after surgery,and there were no significant differences in all the indicators 1 year after surgery compared with 6 months after surgery.Conclusion:The function of knee joint after single condyle replacement showed an overall improvement trend within 6 months,but no significant improvement was observed from 6 months to 12 months after operation.How to improve functional activities faster needs to be attended.