超早期精细化系统管理在膝关节置换术后康复的应用

Application of ultra-early refined systemicrehabilitation treatment under the concept ofenhanced recovery after surgery in total knee arthroplasty

目的 探讨术后加速康复外科(ERAS)理念下超早期精细化系统管理在膝关节置换术(TKA)中的应用效果。方法 在医院行TKA治疗的96例患者随机分为对照组和观察组各48例,均接受常规ERAS管理,观察组另接受超早期精细化系统康复,统计并比较2组的手术相关指标、疼痛程度、膝关节功能、平衡功能、术后不良反应。结果 术后3个月,2组静息、运动状态下的数字模拟(NRS)评分较术前明显降低,膝关节纽约特种外科医院(HSS)评分、Berg量表(BBS)评分明显升高,且观察组优于对照组;治疗组术后下床时间、首次直腿抬高时间、屈膝90°所需天数及住院天数均较对照组缩短,差异有统计学意义(P<0.05)。观察组不良反应总发生率(4.17%)低于对照组(16.67%),差异有统计学意义(χ^(2)=4.019,P=0.045)。结论 基于ERAS理念的超早期精细化系统管理能有效缓解TKA患者术后的疼痛程度,改善患者膝关节和平衡功能,且不良反应少。

Objective To investigate the application and effectiveness of ultra-early refined systemic rehabilitation treatment under the concept of enhanced recovery after surgery(ERAS)in total knee arthroplasty(TKA).Methods A total of 96 patients who underwent TKA in the hospital were randomly divided into a control group and an observation group,with 48 cases in each group.Both groups received routine enhanced recovery after surgery(ERAS)management,while the observation group additionally underwent ultra-early refined systematic rehabilitation.Surgical-related indicators,pain levels,knee joint function,balance function,and postoperative adverse reactions were statistically analyzed and compared between the two groups.Results At three months postoperatively,both groups showed a significant reduction in numerical rating scale(NRS)scores for rest and activity compared to preoperative scores,and a significant increase in hospital for special surgery(HSS)scores and berg balance scale(BBS)scores,with the observation group performing better than the control group.The treatment group had shorter postoperative time to mobilization,first leg raise time,days to achieve 90°knee flexion,and length of hospital stay compared to the control group,with statistically significant differences(P<0.05).The overall incidence of adverse reactions in the observation group(4.17%)was lower than that in the control group(16.67%),with a statistically significant difference(χ^(2)=4.019,P=0.045).Conclusions The ultra-early refined systemic rehabilitation treatment based on ERAS concept can effectively alleviate postoperative pain in patients undergoing total knee arthroplasty(TKA),improve patients'knee joint and balance function,and result in fewer adverse reactions.