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[目的]探讨全膝关节置换术后患者对被动与主动活动康复锻炼方式的心理接受程度及心理状态差异,并分析其对功能恢复的影响。[方法]本院2008年4月~2012年4月收治的单侧膝关节骨性关节炎患者151例,均采用单侧膝关节置换术;随机分为持续被动运动组(continuous passive motion,CPM)和自主训练组(active motion,AM)。比较两组患者年龄、性别、体重指数、手术时间、术后引流量、住院时间、对康复锻炼接受程度、美国特种外科医院膝关节评分(hospital for special surgery,HSS)、关节活动度、医院焦虑抑郁表(hospital anxiety and depression scale,HADS)等。[结果]两组在年龄、性别、体重指数、手术时间、术后引流量的差异无统计学意义(P>0.05)。CPM组平均住院时间为(5.25±0.98)d,AM组为(4.36±0.59)d,AM组平均住院时间比CPM组少(0.89±0.41)d,两组间差异有统计学意义(P<0.05)。CPM组中64%患者表示对CPM恐惧或勉强接受,而在AM组仅为32%(P<0.05)。CPM组平均HADS评分(9.40±3.70)分,而AM组平均HADS评分(6.20±3.10)分,AM组比CPM组少(3.20±0.70)分,两组间差异有统计学意义(P<0.05)。此外,AM组可明显缓解术后早期疼痛及肿胀指数,改善HSS评分及关节活动度(P<0.05),但远期效果差异无统计学意义(P<0.05)。[结论]“自主训练,护理辅助”的康复策略更容易被患者所接受,能早期改善关节功能、缓解局部肿胀及疼痛,是TKA术后早期功能康复训练的方法之一。
[Objective] To explore the psychological acceptance and psychological state of passive and active rehabilitation exercise in patients after total knee arthroplasty and to analyze its effect on functional recovery. [Methods] One hundred and fifteen patients with unilateral knee osteoarthritis admitted from April 2008 to April 2012 in our hospital were treated with unilateral knee arthroplasty. They were randomly divided into continuous passive motion (CPM) ) And the autonomous training group (active motion, AM). The differences of age, sex, body mass index, operation time, postoperative drainage, length of hospital stay, acceptance of rehabilitation exercise, hospital for special surgery (HSS), joint activity, hospital anxiety Depression table (hospital anxiety and depression scale, HADS) and so on. [Results] There were no significant differences in age, sex, body mass index, operation time and postoperative drainage between the two groups (P> 0.05). The average length of hospital stay in CPM group was (5.25 ± 0.98) d, (4.36 ± 0.59) d in AM group, and the average length of stay in AM group was less than that in CPM group (0.89 ± 0.41) d, with significant difference between the two groups (P < 0.05). Sixty-four percent of patients in the CPM group were feared or marginalized for CPM compared to 32% in the AM group (P <0.05). The average HADS score of the CPM group was 9.40 ± 3.70, while the average HADS score of the AM group was 6.20 ± 3.10, while it was less in the AM group than that of the CPM group (3.20 ± 0.70), the difference was statistically significant (P <0.05 ). In addition, AM group could relieve early postoperative pain and swelling index, improve HSS score and joint activity (P <0.05), but the long-term effect was not statistically significant (P <0.05). [Conclusion] The rehabilitation strategy of “independent training and nursing assistant” is more easily accepted by patients. It can improve joint function early and alleviate local swelling and pain. It is one of the methods of early functional rehabilitation training after TKA.