护士主导的医护技联合康复模式在前交叉韧带重建术病人中的应用

Application of Nurse-led Multidisciplinary Rehabilitation Model in the Postoperative Rehabilitation of Anterior Cruciate Ligament Reconstruction

目的探讨护士主导的医护技联合康复模式对前交叉韧带重建术(ACLR)后病人功能恢复和重返运动的影响。方法按照病人入院的先后顺序,将我院骨科2021年1月至6月收治的50例病人纳入对照组,进行常规治疗护理和康复指导;2021年7月至2022年1月收治的50例病人纳入观察组,在常规治疗护理的基础上进行以护士主导的医护技联合康复。观察两组病人术后1~3 d、6个月和12个月数字评分法(NRS)的静、动态疼痛得分,术后首次下床活动时间,术后6个月和12个月国际膝关节文献委员会(IKDC)膝关节主观评分和Lysholm膝关节评分,以及术后重返运动和异常体征情况。结果干预后,观察组术后1~3 d的动、静态NRS疼痛得分和术后6个月的动态NRS疼痛得分显著低于对照组(P<0.05),术后首次下床活动时间早于对照组(P<0.05),术后6个月和12个月IKDC膝关节主观得分和Lysholm膝关节得分均显著高于对照组(P<0.05)。术后1年,观察组关节不稳的发生率明显低于对照组(8.51%vs.25.00%,P=0.032),重返运动率高于对照组(25.53%vs.12.50%,P=0.105)。结论护士主导的医护技联合康复模式可降低ACLR病人术后疼痛,促进病人早期下床活动,减少关节不稳的发生,提高膝关节功能的恢复,但在提高重返运动率方面还需要进一步的远程支持。

Objective To explore the effect of nurse-led multidisciplinary rehabilitation model on postoperative function recovery and return to sports of patients after anterior cruciate ligament reconstruction(ACLR).Methods According to the order of admission,50 patients admitted to our orthopedic department from January to June 2021 were included in the control group for routine treatment,nursing care,and rehabilitation guidance after surgery;50 patients admitted from July 2021 to January 2022 were included in the observation group and underwent nurse-led multidisciplinary rehabilitation in addition to routine treatment and nursing.The static and dynamic pain scores of the Numeric Rating Scale(NRS)at 1-3 days,6 months,and 12 months after surgery,time of first postoperative ambulation,the subjective knee joint score and Lysholm knee joint score of the International Knee Documentation Committee(IKDC)at 6 and 12 months after surgery,as well as the return to movement and abnormal physical signs after surgery were observed and compared between the two groups.Results The dynamic and static NRS pain scores in the observation group 1-3 days after surgery and the dynamic NRS pain score at 6 months after surgery were significantly lower than those in the control group(P<0.05).The time of first postoperative ambulation in the observation group was earlier than that in the control group(P<0.05).The IKDC knee joint subjective scores and Lysholm scores at 6 months and 1 year after surgery in the observation group were significantly higher than those in the control group(P<0.05).The incidence of joint instability in the observation group was significantly lower than that in the control group(8.51%vs.25.00%,P=0.032),and the rate of return to sports in the observation group was higher than that in the control group(25.53%vs.12.50%,P=0.105).Conclusion The nurse-led multidisciplinary rehabilitation model can reduce the pain level after ACLR,promote early ambulation,reduce the occurrence of joint instability,and improve knee joint function recovery.However,further remote support is needed to improve the rate of return to exercise.