全膝關節置換術後病人早期全負重復健之實證應用專案

An evidence-based early weight-bearing rehabilitation protocol for patients who have undergone total knee replacement

周珊珊(Shan-Shan Chou) ； 李怡珍(Yi-Chen Lee) ； 鄭君婷(Chun-Ting Cheng) ； 郭嘉琪(Chia-Chi Kuo)

《台灣實證醫學學會會刊》 11卷2期 (2020/12) Pp. 31-43

https://doi.org/10.6864/EC.202012_11(2).0011

摘要

背景：全膝關節置換術（total knee replacement, TKR）後病人常因患肢腫脹、疼痛，致屈膝角度不佳，影響術後復原。實證文獻建議早期全負重以提升術後主動屈膝角度。目標：TKR病人術後第五天患肢主動屈膝角度≥90度之比率由74.11%提升到95%。方法：藉由知識轉譯與專案手法制定及實施TKR術後早期全負重復健計畫。結果：早期全負重知識轉譯前後測比較，術後第五天病人之患肢主動屈膝角度≥90度比率由74.11%顯著提升到96.03%（p＜.001），並顯著改善術後疼痛（p＜.001）、提升日常生活獨立功能（p＜.001）、與減少住院天數（p＜.001）。結論：本文實證為基礎的「TKR術後早期全負重復健計畫」，可顯著提升病人術後主動屈膝角度≥90度之比率。建議臨床可視照護需求，考慮試行術後早期全負重。

關鍵字

全膝關節置換術 ； 早期全負重 ； 主動屈膝角度 ； 疼痛

並列摘要

Background: Patients who have undergone total knee replacement (TKR) often experience swelling and pain in the affected limb, which results in poor knee flexion angles, and affects postoperative recovery. Empirical literature suggested the adoption of early weight-bearing rehabilitation to increase the postoperative active knee flexion angle. Objective: To increase the rate of TKR patients with the 5th day postoperative active knee flexion angle of ≥ 90° in the affected limb from 74.11% to 95%. Methods: A post-TKR early weight-bearing rehabilitation protocol was formulated and implemented using the knowledge translation and project approaches. Results: Pretest and posttest results of early weight-bearing knowledge translation indicated that the rate of patients with the 5^(th) day postoperative active knee flexion angle of ≥ 90° in the affected limb increased significantly from 74.11% to 96.03% (p ＜ .001). A significant alleviation of postoperative pain (p ＜. 001), increase independence function of activities of daily living (p ＜ .001), and reduction length of hospital stay (p ＜ .001). Conclusions: The evidence-based post-TKR early weight-bearing rehabilitation protocol significantly increased the rate of postoperative active knee flexion angle ≥ 90 ° in patients. Therefore, it is recommended that the clinical setting should be considered the need of care and implementation of postoperative early weight-bearing.

並列關鍵字

total knee replacement ； early weight-bearing ； active knee flexion angle ； pain