置換全人工膝關節後早期下床活動對生活品質 與膝關節彎曲角度恢復程度影響之探討--- 以太平某地區醫院為例

關節置換手術可減輕病患行走時造成之關節疼痛是眾所皆知，但手術後是否能使病人改善其健康的生活質量卻是所知有限。本研究主要目的為探討置換人工膝關節術後早期下床活動與膝關節活動角度恢復程度與生活質量改善之相關性。研究目的包括（1）病人早期下床與常規復健排程下床的差異性？(2)兩種量表KOOS與SF-36分析病人生活品質改善程度，是否有差異性? 研究方法包括，於2018年04月至2018年07月，以台中市某一地區醫院，選定因罹患退化性膝關節炎，並符合可接受人工膝關節置換術（total knee arthroplasty﹐TKA or Mako robotic-arm assisted of TKA）之病患為樣本，排除半人工膝關節置換和再次置換的患者，採用回溯性研究法進行資料收集，追蹤16個接受手術後當天下床活動及同時期16個非手術後當天下床活動之膝關節炎個案，完成其術前及術後1個月的評估。病患需以膝蓋損傷及退化性關節炎量表（Knee Injury and Osteoarthritis Outcome Score, KOOS）計分，檢測膝關節炎症狀程度，SF-36量表則為調查術前健康相關的生活品質；資料分析以SPSS統計分析與卡方檢定來探討病患之人口背景變項、膝關節炎症狀、健康相關的生活品質之間的關係。研究結果如下：一、實驗組與對照組受試者描述性統計:大部分患者屬於年紀大，女性略多於男性；肥胖者多於一般體型者；二、採用KOOS量表量測結果統計分析發現:相較於對照組術前術後變化百分比，實驗組在日常生活活動(ADL)、運動與娛樂(Sport/Rec)和膝關節相關的生活品質(QOL)具明顯改善，但在疼痛(Pain)和症狀(Symptom)這兩個部分並無明顯差異改善。三、採用SF-36量表量測結果統計分析發現:相較於對照組術前術後變化百分比，實驗組在生理狀態(PCS)並無明顯變化，但在心理狀態(MCS)具明顯改善，特別在社會功能(SF) 部分改善最大。結論：針對KOOS與SF-36量表兩組在手術前後之差異性，最終得到結論為；當天下床活動的實驗組病人，在KOOS部分--ADL、Sport/Rec與QOL三者的改善差異性相當大，在SF-36的部分，實驗組MCS > PCS，證明實驗組在日常生活活動、運動與娛樂，膝關節相關的生活品質、社會功能(社交功能)及心理層面，都有明顯改善。當鼓勵病人早期下床活動，其膝關節活動角度改善狀況與健康相關生活品質的改善具明顯正相關性，因此未來在工作上，期許能夠積極引導病人下床活動，讓人工膝關節術後病人能夠得到更佳的照護及預後，也能減少住院天數，相對降低健保支出。

關鍵字

退化性膝關節炎；簡短生活品質量表（MOS SF-36）；膝關節活動角度；膝關節損傷和骨關節炎預後評分（KOOS）；人工膝關節置換術

並列摘要

Reduce pain of patient after knee replacement is achieved and known, but health and quality of life improvement was nearly unknown. The purpose of this study is discussion of improvement of life quality of early postoperative exercise and restore movement angle after knee replacement. The purpose of this study include: 1) the difference between early postoperative exercise and regular arranged rehabilitation schedule; 2) life quality difference between KOOS and SF-36? Study method: sampling from Taichung Hospital between 2018/04-2018/7, all patients received TKA. UKA and revision-TKA patients were excluded. Retrospective study of following 16 patients early excised at the same day of operation and 16 patients with regular scheduled rehabilitation. using KOOS for knee situation and SF-36 for preoperative quality of life evaluation. SPSS and Chi-square test were used for analysis. Study result: 1) Descriptive statistics of the experimental group and the control group: Most of the patients are older, slightly more female than male; more obese than the general body. 2) Using the KOOS scale measurement results statistical analysis found that compared with the control group before and after the percentage of changes, the experimental group in daily life activities (ADL), sports and entertainment (Sport/Rec) and knee-related quality of life (QOL) showed significant improvement, but there was no significant difference in pain (Pain) and Symptom (Symptom). 3) Statistical analysis using the SF-36 scale measurement results showed that there was no significant change in the physiological state (PCS) of the experimental group compared with the control group before and after surgery, but it was significantly improved in the mental state (MCS). Especially improved in the social function (SF) part. Conclusion: The difference between the KOOS and SF-36 questionnaires before and after surgery was finally concluded. The improvement of the KOOS part--ADL, Sport/REC and QOL in the experimental group who got out of bed on the day Quite large, in the SF-36 part, the experimental group MCS >PCS, proved that the experimental group had significant improvement in daily life activities, exercise and entertainment, knee-related life quality, social function and psychological level. When encouraging patients to get out of bed early, the improvement of knee joint activity angle is obviously positively correlated with the improvement of health-related quality of life. Therefore, in the future, in the future, it is expected to actively guide patients to get out of bed and let patients with artificial knee joint surgery. Better care and prognosis can be achieved, and hospital stays can be reduced, and health care costs are reduced.