本文選題：膝關(guān)節(jié)手術(shù) + 膝關(guān)節(jié)骨性關(guān)節(jié)炎�。� 參考：《福建中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:探討膝關(guān)節(jié)表面置換術(shù)(Total Knee Arthroplasty,TKA)術(shù)后進(jìn)行早期閉鏈?zhǔn)焦δ苠憻挼呐R床意義。方法:前瞻性分析2015年11月至2016年10月于我院治療并符合納入標(biāo)準(zhǔn)的膝關(guān)節(jié)表面置換術(shù)術(shù)后患者60例�；颊唠S機(jī)分為早期閉鏈功能鍛煉組(試驗(yàn)組)30例和對(duì)照組30例。試驗(yàn)組術(shù)后即行踝泵運(yùn)動(dòng)、手術(shù)24h之后行屈膝屈髖鍛煉、手術(shù)72h之后行直立屈膝功能鍛煉、手術(shù)后1周行類似踩平衡板運(yùn)動(dòng)、手術(shù)3周之后行單腿直立屈曲鍛煉。對(duì)照組患者手術(shù)即行踝泵運(yùn)動(dòng),手術(shù)24h之后行直腿抬高鍛煉、手術(shù)72h之后行壓腿功能鍛煉、手術(shù)1周之后行床邊屈膝鍛煉。對(duì)比試驗(yàn)組患者與對(duì)照組患者術(shù)前、術(shù)后1周、術(shù)后3周、術(shù)后6周及術(shù)后3個(gè)月的美國(guó)特種醫(yī)院的評(píng)分系統(tǒng)(Hospital for Special Surgery,HSS)、術(shù)前及術(shù)后第2、3個(gè)月后視覺(jué)模擬評(píng)分(Visual Analogue Scale,VAS),統(tǒng)計(jì)兩組患者并發(fā)癥發(fā)生情況。結(jié)果:術(shù)前兩組患者的年齡、性別、手術(shù)節(jié)段、體重指數(shù)、HSS、VAS評(píng)分無(wú)明顯差異(P0.05)。所有患者均獲得隨訪。試驗(yàn)組2名患者未按規(guī)定鍛煉、對(duì)照組3名患者未按規(guī)定鍛煉予以剔除。兩組患者術(shù)后HSS評(píng)分與術(shù)前比均顯著改善(P0.05),術(shù)后1周、術(shù)后3周、術(shù)后6周以及術(shù)后3個(gè)月試驗(yàn)組患者的HSS評(píng)分優(yōu)于對(duì)照組(P0.05)。兩組患者術(shù)后VAS評(píng)分與術(shù)前比均顯著改善(P0.005),術(shù)后第2個(gè)月試驗(yàn)組患者VAS評(píng)分優(yōu)于對(duì)照組(P0.05),而術(shù)后3個(gè)月兩組患者間的HSS評(píng)分結(jié)果差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.353)。對(duì)照組1例患者出現(xiàn)切口愈合不良,予持續(xù)換藥觀察,對(duì)滲出做培養(yǎng),并且做出相關(guān)處理后予以剔除,余患者術(shù)后均未發(fā)生下肢深靜脈血栓、感染等并發(fā)癥。結(jié)論:膝關(guān)節(jié)表面置換術(shù)術(shù)后患者進(jìn)行早期閉鏈?zhǔn)焦δ苠懢毮艽龠M(jìn)其早期康復(fù)、提高療效,并且是安全可行的。
[Abstract]:Objective: to investigate the clinical significance of early closed chain exercise after total knee arthroplasty. Methods: from November 2015 to October 2016, 60 patients who were treated in our hospital and met the standard of knee arthroplasty were analyzed prospectively. Patients were randomly divided into early closed chain function exercise group (30 cases in the experimental group and 30 cases in the control group). In the experimental group, ankle pump exercise was performed immediately after operation, knee flexion and hip flexion exercise was performed 24 hours after operation, orthostatic flexion function exercise was performed 72 hours after operation, similar balance plate exercise was performed 1 week after operation, and one leg upright flexion exercise was performed 3 weeks after operation. The patients in the control group underwent ankle pump exercise 24 hours after operation straight leg elevation exercise 72 hours after operation and knee bending exercise at the bedside after 1 week operation. The patients in the trial group were compared with those in the control group before operation, 1 week after operation and 3 weeks after operation. Six weeks after operation and three months after operation, the scoring system of for Special SurgeryHSS in American Special Hospitals was used. Visual Analogue scale and visual analogue scale were evaluated before and 2 and 3 months after operation. The complications of the two groups were calculated. Results: there was no significant difference in age, sex, operative segment, body mass index (BMI) and VAS score between the two groups (P 0.05). All patients were followed up. Two patients in the test group did not exercise as required, and three patients in the control group were excluded. The HSS scores of the two groups were significantly improved than those of the control group. The HSS scores in the trial group were significantly better than those in the control group at 1 week, 3 weeks, 6 weeks and 3 months after operation. The VAS scores in the two groups were significantly improved compared with those before operation (P 0.005). The VAS scores in the test group were better than those in the control group (P 0.05) at the 2nd month after operation, but there was no significant difference in HSS score between the two groups at 3 months after operation. In the control group, one patient had bad wound healing and was observed by continuous dressing change. The exudation was cultured and removed after treatment. No complications such as deep vein thrombosis and infection occurred in the remaining patients after operation. Conclusion: it is safe and feasible for the patients after knee surface replacement to carry out early closed chain exercise to promote their early recovery and improve the curative effect.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R473.6

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