目的 探讨基于患者居家需求的情境模拟康复管理对全膝关节置换术(total knee arthroplasty,TKA)后患者下肢运动功能及生活质量的影响.方法 选取 2021 年 3 月至 2022 年 9 月我院收治的 90 例老年 TKA 术后患者作为研究对象,按照随机数表法分为对照组(n = 45)和试验组(n = 45).对照组采用术后常规康复训练;试验组在术后常规康复训练基础上加用基于患者居家需求的情境模拟康复管理.比较两组患者的美国特种外科医院(The Hospital For Special Surgery,HSS)评分、6 min 步行试验(6 minutes walk test,6MWT)、膝关节活动度(range of motion,ROM)、疼痛视觉模拟评分(visual analogue scale,VAS)、生活质量综合评定问卷(generic quality of life inventory 74,GQOLI-74)以及术后假体松动、深静脉血栓和感染的并发症发生率.结果 术后 2 个月,HSS 评分:对照组 50.62±6.43,试验组 56.42±6.87;6MWT:对照组(342.45±12.98)m,试验组(366.09±13.56)m;ROM:对照组(91.22±6.01)°,试验组(96.35±6.32)°;术后 6 个月,HSS 评分:对照组 76.87±6.11,试验组 84.21±8.25;6MWT:对照组(395.34±12.07)m,试验组(429.65±14.14)m;ROM:对照组(115.27±5.27)°,试验组(119.31±5.84)°;术后 2 个月和 6 个月,试验组的 HSS评分、6MWT、ROM 大于对照组,差异有统计学意义(P<0.05).VAS 评分对照组术后 1 个月、2 个月、3 个月分别为 3.33±0.85、1.67±0.41、0.99±0.23,试验组分别为 2.87±0.77、1.25±0.32、0.78±0.12;术后 1 个月、2 个月、3 个月,两组患者的 VAS 评分均随时间降低,且试验组的 VAS 评分均低于对照组,差异有统计学意义(P<0.05).术后 6 个月,试验组的生活质量高于对照组,差异有统计学意义(P = 0.002).术后 6 个月,试验组患者的术后假体松动、深静脉血栓和感染的并发症发生率为 8.89%,对照组为 15.56%,差异无统计学意义(P>0.05).结论 基于患者居家需求的情境模拟康复管理可以提升老年 TKA 术后患者的下肢运动功能,降低术后疼痛程度,提升患者生活质量,值得临床推广.
Application of situational simulation rehabilitation management based on patients'home demand in patients after total knee arthroplasty
Objective To explore the effects of situational simulation rehabilitation management based on patients'home demand on lower limb motor function and quality of life in patients after total knee arthroplasty(TKA).Methods A total of 90 elderly patients after TKA were enrolled from March 2021 to September 2022,and all were randomly divided into control group(45 cases)and experimental group(45 cases)according to random number table method.The control group received routine rehabilitation training after operation.In the experimental group,the routine rehabilitation training was supplemented with situational simulation rehabilitation management based on patients'home needs.The hospital for special surgery(HSS score),6-minute walk test(6MWT),range of motion(ROM),visual analogue scale(VAS),Generic Quality of Life Inventory 74(GQOLI-74),and the incidence of postoperative complications such as prosthetic loosening,deep vein thrombosis,and infection were compared between the two groups of patients.Results HSS scores 2 months after surgery:control group 50.62±6.43,experimental group 56.42±6.87.6MWT 2 months after surgery:control group(342.45±12.98)m,experimental group(366.09±13.56)m.ROM 2 months after surgery:control group(91.22±6.01)°,experimental group(96.35±6.32)°.HSS scores 6 months after surgery:control group 76.87±6.11,experimental group 84.21±8.25.6MWT 6 months after surgery:control group(395.34±12.07)m,experimental group(429.65±14.14)m.ROM 6 months after surgery:control group(115.27±5.27)°,experimental group(119.31±5.84)°.HSS score,6MWT,and ROM of the experimental group were higher than those of the control group at 2 months and 6 months after surgery,and the differences were statistically significant(P<0.05).The VAS scores of the control group were 3.33±0.85,1.67±0.41,and 0.99±0.23 at 1 month,2 months,and 3 months after surgery,respectively,while the experimental group were 2.87±0.77,1.25±0.32,and 0.78±0.12,respectively.The results showed that at 1,2,and 3 months after surgery,the VAS of both groups decreased with time,and the VAS scores of the experimental group were lower than those of the control group,with statistically significant differences(P<0.05).Six months after surgery,the quality of life in the experimental group was higher than that in the control group,and the differences were statistically significant(P = 0.002).Six months after surgery,the incidence of postoperative complications such as prosthetic loosening,deep vein thrombosis,and infection in the experimental group was 8.89%,with no statistically significant difference compared to 15.56%in the control group(P>0.05).Conclusions The situational simulation rehabilitation treatment management based on patients'home demand can improve lower limb motor function of elderly patients after TKA,relieve postoperative pain and improve quality of life,which is worthy of clinical promotion.
RehabilitationArthroplasty,replacement,kneeQuality of life
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