2018 年第 4 期 第 13 卷

以无痛锻炼为核心的快速康复方案对全膝关节置换术后康复效果的影响

Effect of rapid rehabilitation therapy based on painless exercise on postoperative recovery of total knee arthroplasty

作者：李新天王炜林进

英文作者：

单位：100049北京，航天中心医院骨科（李新天）；100730中国医学科学院北京协和医学院北京协和医院骨科（王炜、林进）

英文单位：

关键词：快速康复；全膝关节置换术；镇痛

英文关键词：

• 摘要：

• 目的    观察以无痛锻炼为核心的快速康复方案对全膝关节置换术后康复效果的影响。方法    选取2017年1—4月北京协和医院骨科收治的行初次单侧全膝关节置换术的膝关节骨性关节炎患者60例，完全随机分为快速康复组和传统康复组，各30例。快速康复组采用快速康复方案，术前健康宣教并指导患者进行肌肉力量练习，术中采取改良鸡尾酒关节周围浸润注射镇痛，采取快速康复理念指导下的血液管理、引流管放置及术后康复。传统康复组采用传统康复方案，术后采用自控静脉镇痛泵。比较2组患者术后6、12、24、48、72 h膝关节的静态及动态疼痛视觉模拟量表（VAS）评分，术后48、72 h膝关节的最大屈曲活动度，记录2组术后主动直腿抬高时间、下地时间、住院时间、术后引流量、满意度。记录2组术后并发症及不良反应发生情况。结果    快速康复组术后6、12、24、48、72 h静态、动态VAS评分低于传统康复组，差异均有统计学意义（均P<0.01）。术后48、72 h快速康复组膝关节最大屈曲活动度大于传统康复组，主动直腿抬高时间、下地时间、住院时间短于传统康复组，术后引流量小于传统康复组，满意度得分高于传统康复组［（97±10）°比（76±15）°、（106±12）°比（86±8）°、2.0(2.0,4.0)h比44.0(24.0,48.0)h、26.2(25.5,46.5)h比56.4(32.5,69.5)h、4.8(3.5,5.5)d比5.9(5.5,6.5)d、210.0(100.0,300.0)ml比350.0(247.5,450.0)ml、8.9(7.5,9.5)分比7.5(6.5,8.5)分］，差异均有统计学意义（均P<0.01）。2组并发症发生率差异无统计学意义（P>0.05），2组均无特殊不良反应发生。结论    以无痛锻炼为核心的快速康复方案对于TKA术后关节功能快速恢复起重要作用，患者满意度高，住院时间短。

• Objective    To observe the effect of rapid rehabilitation therapy based on painless exercise on recovery of patients with total knee arthroplasty. Methods    Sixty patients undergoing total knee arthroplasty from January to April 2017 in Peking Union Medical College Hospital were randomly divided into rapid rehabilitation group and traditional rehabilitation group, with 30 cases in each group. The rapid rehabilitation group received preoperative education for health guidance and muscle strength exercise; patients had modified cocktail joint infiltration anesthesia and analgesia; enhanced recovery measures were applied after surgery. The traditional rehabilitation group had routine recovery therapy and self-controlled analgesia. Pain Visual Analogue Scale(VAS) score was recorded 6, 12, 24, 48, 72 h after surgery. The maximum motion range of knee joint was assessed 48 and 72 h after surgery. Postoperative straight leg raise time, ambulation time, hospital stay time, drainage volume and patient satisfaction were analyzed. Complications and adverse reactions were observed. Results   Static and dynamic VAS scores 6, 12, 24, 48, 72 h after surgery in rapid rehabilitation group were significantly lower than those in traditional rehabilitation group(P<0.01). At 48 and 72 h after surgery, the maximum motion angle of knee joint was significantly larger, straight leg raise time, ambulation time and hospital stay time were significantly shorter, drainage volume was significantly less and patient satisfaction score was significantly higher in rapid rehabilitation group than those in traditional rehabilitation group［（97±10）° vs （76±15）°,（106±12）° vs （86±8）°, 2.0(2.0,4.0)h vs 44.0(24.0,48.0)h, 26.2(25.5,46.5)h vs 56.4(32.5,69.5)h, 4.8(3.5,5.5)d vs 5.9(5.5,6.5)d, 210.0(100.0,300.0)ml vs 350.0(247.5,450.0)ml, 8.9(7.5,9.5)points vs 7.5(6.5,8.5)points］(P<0.01). Incidence of complications showed no significant difference between groups(P>0.05). No severe adverse reaction was observed. Conclusion    Rapid rehabilitation therapy based on painless exercise can effectively improve patient satisfaction, shorten hospitalization time and promote postoperative recovery in patients undergoing total knee arthroplasty.