术前预康复对全膝关节置换术后早期功能恢复效果的影响

Effects of preoperative pre-rehabilitation on early functional recovery after total knee arthroplasty

目的探讨在加速康复外科多学科协作模式下术前预康复对膝关节置换术后早期功能恢复效果的影响。方法回顾性分析2019年9月至2021年12月在晋江市医院骨科接受全膝关节置换术患者51例的临床资料,将51例患者中按术前是否采用术前预康复分为观察组(24例)和对照组(27例),在行膝关节置换术前进行预康复的设为观察组,术前未进行预康复的设为对照组。观察组在办理入院手续后,前往康复门诊进行康复评估,并在同一个康复师指导下行个性化康复训练,后续手术后康复师跟进术后康复。对照组则无术前预康复,术后康复师及时介入康复,康复师在术后2 d和5 d分别对患者进行康复评分(HSS评分、运动疼痛目测类比评分等)。主要观察指标:患者术后2 d、5 d膝关节活动度(range of motion,ROM);术后2 d、5 d膝关节功能评价表(hospital for special surgery knee score,HSS);术后5 d运动疼痛目测类比评分(visual analogous scale,VAS);术后至出院天数;术后并发症发生率;术后康复科门诊回访情况等。结果观察组与对照组术后2 d ROM评分差异无统计学意义(P>0.05),两组术后5 d ROM评分差异有统计学意义[(100.08±7.75)分比(88.44±16.09)分,t=3.34,P=0.002];术后2 d两组HSS评分差异无统计学意义(P>0.05),术后5 d两组HSS评分差异有统计学意义[(62.84±5.78)分比(57.09±6.53)分,t=3.31,P=0.002];术后5 d两组VAS(运动时)评分差异有统计学意义[(3.42±1.02)分比(5.37±1.15)分,t=-6.39,P<0.001];两组术后至出院天数差异无统计学意义(P>0.05)。术后并发症发生率差异无统计学意义(P>0.05),两组术后康复科门诊回访情况差异有统计学意义[(7/17)比(1/26),χ^(2)=4.45,P=0.035]。结论加速康复外科多学科协作模式下术前预康复有助于提高全膝关节置换术患者的早期功能水平,降低术后康复疼痛感,提高患者术后康复依从性,提升患者对手术的满意度。

Objective To investigate the effects of preoperative pre-rehabilitation on early functional recovery after knee arthroplasty under the multidisciplinary collaboration mode of accelerated rehabilitation surgery.Methods The clinical data of 51 patients who underwent total knee arthroplasty in the Department of Orthopedics,Jinjiang Hospital from September 2019 to December 2021 were retrospectively analyzed.These patients were divided into an observation group(n=24)and a control group(n=27).The observation group received pre-rehabilitation before knee replacement surgery,while the control group did not.After completing the admission procedures,patients in the observation group underwent rehabilitation evaluation in the rehabilitation clinic and received individualized rehabilitation training.The control group did not undergo preoperative pre-rehabilitation but underwent the same individualized rehabilitation training as the observation group.The rehabilitation specialist evaluated the patients'rehabilitation scores[hospital for special surgery knee(HSS)score,visual analog scale(VAS)score]at 2 and 5 days after surgery.The main outcome measures included the range of motion(ROM)of the patient's knee joint at 2 and 5 days after surgery,HSS score at 2 and 5 days after surgery,VAS score at 5 days after surgery,the number of days from surgery to discharge,the incidence of postoperative complications,and the rate of outpatient visits after surgery.Results There was no significant difference in postoperative ROM of the knee joint between the observation and control groups at 2 days after surgery(P>0.05).However,there was a significant difference in score of ROM of the knee joint at 5 days after surgery between the two groups[(100.08±7.75)points vs.(88.44±16.09)points,t=3.34,P=0.002].There was no significant difference in HSS score between the two groups at 2 days after surgery(P>0.05).However,there was a significant difference in HSS score between the two groups at 5 days after surgery[(62.84±5.78)points vs.(57.09±6.53)points,t=3.31,P=0.002].There was a significant difference in VAS score(exercise)between the two groups at 5 days after surgery[(3.42±1.02)points vs.(5.37±1.15)points,t=-6.39,P<0.001].There was no significant difference in the number of days from surgery to discharge between the two groups(P>0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).However,there was a significant difference in the rate of outpatient visits between the two groups[7/17 vs.1/26,χ^(2)=4.45,P=0.035].Conclusion Preoperative pre-rehabilitation in the accelerated rehabilitation surgery model under multidisciplinary collaboration can help improve the early function of patients undergoing total knee arthroplasty,reduce the pain of postoperative rehabilitation,improve the postoperative rehabilitation compliance,and ultimately enhance patient satisfaction with the surgery.