早期全負重對全膝關節置換術後病人復健成效之系統性文獻回顧

背景：全膝關節置換術後病人常因患肢腫脹疼痛，致屈膝角度不佳，影響復健成效與日常活動功能。實證文獻建議早期全負重可提升術後復健成效，但卻缺乏系統性文獻回顧探討整體成效。目標：透過系統性文獻回顧探討早期全負重於全膝關節置換術後病人之膝關節功能、疼痛、生活品質與住院天數等復健成效。方法：系統性搜尋六個中英文資料庫，鍵入「膝關節置換術」與「早期全負重」之MeSH與同義詞等中英文關鍵字，共2篇隨機控制試驗符合納入條件，由兩位評讀員獨立以牛津實證醫學中心之隨機控制試驗嚴格評讀表評讀文獻品質與萃取資料。結果：2篇文獻證據等級皆為Level 2。系統性文獻回顧顯示術後早期全負重可顯著提升膝關節功能、改善術後疼痛與縮短住院天數，生活品質得分則無顯著差異。結論：系統性文獻回顧僅2篇隨機控制試驗探討早期全負重成效，證據力顯薄弱，但考量早期全負重無顯著副作用，現有證據顯示全膝關節置換術後病人執行早期全負重可顯著提升多個術後復建成效。建議臨床可試推行早期全負重方案，並藉由追蹤分析探討知識轉譯成效。

關鍵字

早期全負重；全膝關節置換術；系統性文獻回顧

並列摘要

Background: After total knee replacement, patients often suffer swelling and pain, resulting in poor knee flexion angles and affecting rehabilitation effectiveness and activities of daily living. Empirical literature suggests that early weight-bearing can improve the effectiveness of rehabilitation; however, there is a lack of a systematic review to explore the overall effects. Objective: To explore the effectiveness of rehabilitation of early weight-bearing on knee function, pain, quality of life, and length of hospital stay in patients after total knee replacement through a systematic review. Methods: Six Chinese and English databases were searched. The search terminologies were ＂total knee replacement＂ and ＂early weight-bearing,＂ which included medical subject headings and synonyms. Two randomized control trials that met the criteria were used in the analysis. Two reviewers used the randomized control trials critical appraisal sheet of the Oxford Centre for Evidence-Based Medicine to independently assess literature quality and extract data. Results: The level of evidence of the two reviewed articles was Level 2. The systematic review showed that early weight-bearing can significantly improve knee function, improve post-operative pain, and shorten the length of hospital stay, but there is no significant effect on the quality of life. Conclusions: The systematic review revealed only two randomized control trials that explored the effects of early weight-bearing, showing that the evidence is weak. However, considering that early weight-bearing has no significant side effects, the available evidence shows that performing weight-bearing after total knee replacement can significantly improve the effectiveness of postoperative rehabilitation. We suggest that clinical settings can introduce early weight-bearing protocols and explore the effect of knowledge translation through tracking analysis.

並列關鍵字

early weight-bearing ； total knee replacement ； systematic review

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早期全負重對全膝關節置換術後病人復健成效之系統性文獻回顧

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