發(fā)布時間：2018-01-07 08:26

  本文關(guān)鍵詞：術(shù)后恐動癥對單側(cè)全膝關(guān)節(jié)置換患者康復(fù)結(jié)局的影響　出處：《鄭州大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 全膝關(guān)節(jié)置換術(shù) 恐動癥 膝關(guān)節(jié) 疼痛 屈曲度

【摘要】：目的探討術(shù)后恐動癥對單側(cè)全膝關(guān)節(jié)置換患者康復(fù)結(jié)局的影響;調(diào)查單側(cè)全膝關(guān)節(jié)置換患者術(shù)后恐動癥發(fā)生現(xiàn)狀;了解單側(cè)全膝關(guān)節(jié)置換患者術(shù)后恐動癥發(fā)生現(xiàn)狀及其與康復(fù)結(jié)局之間的相關(guān)性,以便為單側(cè)全膝關(guān)節(jié)置換患者實施針對性的干預(yù)提供循證依據(jù)。方法1.根據(jù)本研究的納入和排除標準便利選取2015年9月~2016年5月在鄭州大學(xué)第一附屬醫(yī)院骨科接受單側(cè)全膝關(guān)節(jié)置換術(shù)的患者244例。2.所有患者于術(shù)后48h內(nèi)收集基線資料及空腹血糖、血紅蛋白等生化指標,并運用恐動癥Tampa評分表(TSK)對全膝關(guān)節(jié)置換患者進行評估,恐動癥Tampa評分得分37分即可認為患者伴有恐動癥。3.研究者分別于術(shù)后2周(住院期間)、4周、3個月、6個月對244例患者進行隨訪調(diào)查。術(shù)后2周、4周時,運用疼痛數(shù)字評分表及量角器評估患者術(shù)后膝關(guān)節(jié)疼痛程度及膝關(guān)節(jié)屈曲度;術(shù)后3個月及術(shù)后6個月時除了收集以上信息外,仍需運用美國膝關(guān)節(jié)協(xié)會評分表對患者膝關(guān)節(jié)功能進行評估。4.采用SPSS19.0軟件對研究數(shù)據(jù)進行統(tǒng)計分析,運用描述性統(tǒng)計分析對患者的一般資料進行描述。運用卡方檢驗對組間分類變量進行比較。運用重復(fù)測量方差分析對結(jié)局變量的變化趨勢進行判斷。運用Pearson相關(guān)性檢驗分析單側(cè)全膝關(guān)節(jié)置換患者術(shù)后恐動癥與術(shù)后膝關(guān)節(jié)疼痛、膝關(guān)節(jié)屈曲度以及膝關(guān)節(jié)功能之間的相關(guān)性。P0.05有顯著性統(tǒng)計學(xué)意義。結(jié)果1.本研究共納入單側(cè)全膝關(guān)節(jié)置換患者244例,平均年齡為66.95±7.53歲,其中179例女性患者占74.27%,213例已婚患者占88.38%�；颊呖謩影YTampa評分平均得分為36.80±10.89,平均體質(zhì)指數(shù)為24.98±3.67,平均空腹血糖為4.82±0.77 mmol/L。經(jīng)過6個月的隨訪,失訪3例,失訪率1.23%。實際納入研究對象為241例。2.全膝關(guān)節(jié)置換患者術(shù)后恐動癥發(fā)生現(xiàn)狀:在241例研究對象中,伴有恐動癥的患者為67例,無恐動癥患者為174例,全膝關(guān)節(jié)置換患者術(shù)后恐動癥發(fā)生率為27.80%。3.恐動組與無恐動組患者術(shù)后膝關(guān)節(jié)疼痛程度的比較:在術(shù)后2周、4周、3個月、6個月,統(tǒng)計兩組患者的術(shù)后膝關(guān)節(jié)疼痛程度,運用重復(fù)測量方差分析對數(shù)據(jù)進行統(tǒng)計分析,結(jié)果表明,在各個評價時間點恐動組患者的疼痛強度均明顯高于無恐動組,具有顯著性統(tǒng)計學(xué)意義(P0.05)。4.恐動組與無恐動組患者術(shù)后膝關(guān)節(jié)屈曲度比較:在術(shù)后2周、4周、3個月、6個月,統(tǒng)計兩組患者的術(shù)后膝關(guān)節(jié)屈曲度,運用重復(fù)測量方差分析對數(shù)據(jù)進行統(tǒng)計分析,結(jié)果表明,在各個評價時間點恐動組患者的術(shù)后膝關(guān)節(jié)屈曲度均明顯低于無恐動組,具有顯著性統(tǒng)計學(xué)意義(P0.05)。5.恐動組與無恐動組患者術(shù)后膝關(guān)節(jié)功能評分比較:在術(shù)后3個月、6個月,統(tǒng)計兩組患者的膝關(guān)節(jié)功能評分,運用兩獨立樣本t檢驗對數(shù)據(jù)進行統(tǒng)計分析,結(jié)果表明,恐動組患者的膝關(guān)節(jié)功能評分均明顯低于無恐動組,具有顯著性統(tǒng)計學(xué)意義(P0.05)。6.隨著時間推移,兩組患者的疼痛強度和關(guān)節(jié)屈曲度均有所改善運用重復(fù)測量方差分析對兩組患者的膝關(guān)節(jié)疼痛強度及膝關(guān)節(jié)屈曲度進行統(tǒng)計分析,結(jié)果顯示,兩組患者在各個時間點的膝關(guān)節(jié)疼痛程度不同,恐動組患者術(shù)后膝關(guān)節(jié)疼痛程度均高于無恐動組患者,具有顯著性統(tǒng)計學(xué)意義(P0.05);兩組患者在各個時間點的術(shù)后膝關(guān)節(jié)屈曲度不同,恐動組患者術(shù)后膝關(guān)節(jié)屈曲度均低于無恐動組,具有顯著性統(tǒng)計學(xué)意義(P0.05)。在術(shù)后2周到4周,無恐動組患者的膝關(guān)節(jié)疼痛強度和膝關(guān)節(jié)屈曲度均有明顯改善(P0.05);術(shù)后4周到3個月,術(shù)后3個月到6個月,兩組患者術(shù)后膝關(guān)節(jié)疼痛強度變化程度的差異無統(tǒng)計學(xué)意義(P0.05)。另外,術(shù)后2周到4周,無恐動組患者術(shù)后膝關(guān)節(jié)屈曲度變化程度明顯(t=2.654,P0.05);術(shù)后4周到3個月,恐動組患者術(shù)后膝關(guān)節(jié)屈曲度變化程度明顯(t=2.763,P0.05)。7.術(shù)后恐動癥與全膝關(guān)節(jié)置換患者康復(fù)結(jié)局之間的相關(guān)性在所有時間點的測量中,全膝關(guān)節(jié)置換患者恐動癥Tampa評分得分與術(shù)后膝關(guān)節(jié)屈曲度之間存在負相關(guān),其中,術(shù)后2周兩者呈高度負相關(guān)(r=-0.72,P0.05),術(shù)后4周、術(shù)后3個月及術(shù)后6個月,兩者呈中度負相關(guān)(P0.05)。在所有時間點的測量中,全膝關(guān)節(jié)置換患者恐動癥Tampa評分得分與術(shù)后膝關(guān)節(jié)疼痛程度之間存在正相關(guān),其中,術(shù)后4周呈高度正相關(guān)(r=0.76,P0.05),術(shù)后2周及術(shù)后3個月呈中度正相關(guān)(P0.05),術(shù)后6個月呈低度正相關(guān)(r=0.24,P0.05)。全膝關(guān)節(jié)置換患者TSK得分與膝關(guān)節(jié)功能評分之間呈負相關(guān),術(shù)后3個月呈中等負相關(guān)(r=-0.33,P0.05),術(shù)后6個月呈低度負相關(guān)(r=-0.28,P0.05)。結(jié)論1.術(shù)后恐動癥對單側(cè)全膝關(guān)節(jié)置換患者康復(fù)結(jié)局存在負性影響;2.無恐動癥的患者膝關(guān)節(jié)功能恢復(fù)良好;3.臨床醫(yī)務(wù)人員應(yīng)針對全膝關(guān)節(jié)置換患者術(shù)后恐動癥實施干預(yù)措施,以提高全膝關(guān)節(jié)置換患者的康復(fù)效果,提高患者生活質(zhì)量。
[Abstract]:Objective to investigate the postoperative effect on fear of moving in unilateral total knee replacement patients rehabilitation outcome; fear of moving in investigation of unilateral total knee replacement surgery patients; understand the unilateral total knee replacement surgery patients fear of moving correlation between disorder and the present situation of rehabilitation, so as to provide evidence for the intervention of the implementation evidence for unilateral total knee replacement patients. Methods 1. according to the inclusion and exclusion criteria of convenience from September 2015 ~2016 year in May 244 Cases.2. Department of orthopedics the First Affiliated Hospital of Zhengzhou University underwent unilateral total knee arthroplasty patients in all patients within 48h after collecting baseline data and fasting blood glucose, hemoglobin and other biochemical indicators, and the fear of sickness Tampa scale (TSK) assessment of patients undergoing total knee arthroplasty, fear of moving in the Tampa scores 37 points to be considered in.3. of patients with fear of moving persons In 2 weeks after operation (hospitalization), 4 weeks, 3 months, 6 months follow-up study was performed in 244 patients. After 2 weeks, 4 weeks, the pain score table and evaluation of patients with postoperative protractor knee pain and knee flexion; 3 months after the operation and after 6 months in addition to collect the above information, still need to use the American Knee Society was assessed with the.4. SPSS19.0 software was used for statistical analysis of research data on patients with knee joint function score, using descriptive statistical analysis to describe the general information of patients. For comparison between the groups for categorical variables using chi square test. Using repeated measures analysis of variance change trend on the outcome variable to judge. Analysis of unilateral total knee arthroplasty in patients with postoperative fear sickness and postoperative pain of knee joint using the Pearson correlation test, the relationship between knee flexion and knee joint function There was a statistical significance.P0.05. 1. results of this study included 244 Cases of unilateral total knee replacement patients, the average age was 66.95 + 7.53 years, including 179 cases of female patients accounted for 74.27%, 213 cases of married patients accounted for 88.38%. patients in fear of moving average Tampa score score was 36.80 + 10.89, the average body mass index was 24.98. 3.67, the average fasting blood glucose was 4.82 + 0.77 mmol/L. after 6 months of follow-up, 3 cases were lost, the lost rate of 1.23%. in this study included 241 cases of.2. patients after total knee arthroplasty in fear of moving status: in 241 patients, with fear of moving patients 67 cases no fear of moving patients for 174 cases, total knee arthroplasty in patients with postoperative disease incidence for fear of moving 27.80%.3. fear of moving groups with and without fear of moving patients after knee joint pain: after 2 weeks, 4 weeks, 3 months, 6 months, two groups were statistical after knee joint pain, Using repeated measures ANOVA statistical analysis of the data showed that, in the evaluation of each time point fear of moving pain intensity groups were significantly higher than those without fear of moving group, with significant difference (P0.05) of.4. group and without fear of fear of moving dynamic groups of patients with knee flexion: after 2 week, 4 weeks, 3 months, 6 months, statistics of two groups of patients with postoperative knee flexion, using repeated measures ANOVA statistical analysis of data showed that, in the evaluation of each time point fear of moving the group of patients with postoperative knee flexion were significantly lower than the group with no fear. Statistical significance (P0.05).5. fear of moving groups with and without fear of moving patients after knee joint function score: 3 months after operation, 6 months, the knee joint function score statistics of two groups of patients, using two independent sample t test for statistical analysis of data. The results show that the fear of moving The knee function score of patients were significantly lower than those without fear of moving group, with significant statistical significance (P0.05).6. with the passage of time, the two groups of patients with pain intensity and joint flexion were improved by using repeated measures ANOVA of knee pain in the two groups of patients of knee joint flexion for statistical analysis the results showed that two groups of patients in different time points of knee joint pain, fear of moving groups of patients with knee joint pain were higher than those without fear of moving groups, with statistical significance (P0.05); the two groups of patients at each time point after operation of knee flexion, fear of moving patients the postoperative knee flexion were lower than those without fear of moving group, with significant statistical significance (P0.05). After 2 to 4 weeks, without fear of moving patients with knee pain and knee flexion strength were significantly improved (P0.05); operation 鍚，

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