| 类风湿关节炎患者全膝关节置换术后劳动功能康复情况分析 |
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Received:December 12, 2024
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| 作者 | Author | 单位 | Unit | E-Mail |
| 柯彤 |
KE Tong |
陕西中医药大学, 陕西 咸阳 712000 |
Shaanxi University of Traditional Chinese Medicine, Xianyang 712000, Shaanxi, China |
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| 郝阳泉 |
HAO Yang-quan |
西安交通大学附属红会医院, 陕西 西安 710000 |
Honghui Hospital, Xi'an Jiaotong University, Xi'an 710000, Shaanxi, China |
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| 王孟飞 |
WANG Meng-fei |
陕西中医药大学, 陕西 咸阳 712000 |
Shaanxi University of Traditional Chinese Medicine, Xianyang 712000, Shaanxi, China |
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| 闫宇衡 |
YAN Yu-heng |
西安交通大学附属红会医院, 陕西 西安 710000 |
Honghui Hospital, Xi'an Jiaotong University, Xi'an 710000, Shaanxi, China |
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| 蔡元真 |
CAI Yuan-zhen |
西安交通大学附属红会医院, 陕西 西安 710000 |
Honghui Hospital, Xi'an Jiaotong University, Xi'an 710000, Shaanxi, China |
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| 鲁超 |
LU Chao |
西安交通大学附属红会医院, 陕西 西安 710000 |
Honghui Hospital, Xi'an Jiaotong University, Xi'an 710000, Shaanxi, China |
luchao0925@163.com |
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| 期刊信息：《中国骨伤》2025年38卷，第6期，第594-600页 |
| DOI：10.12200/j.issn.1003-0034.20240471 |
| 基金项目:陕西省重点研发计划(编号:2024SF-ZDCYL-04-12) |
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目的：探讨类风湿关节炎(rheumatoid arthritis,RA)患者行全膝关节置换(total knee arthroplasty,TKA)术后功能康复情况。
方法：回顾性分析2017年1月至2020年12月因RA累及双膝需行TKA的101例患者,男16例,女85例,年龄41~65(58.13±5.53)岁;身体质量指数(body mass index,BMI)为16.88~33.33(23.16±3.49) kg·m-2;根据美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级,1级63例,2级29例,3级9例。根据术后12个月随访结果,重返工作岗位82例,未重返工作岗位19例。分别于术前及术后12个月采用疼痛视觉模拟评分(visual ana-logue scale,VAS)评价所有患者疼痛缓解程度,采用工作、骨关节炎和关节置换问卷(work,osteoarthritis and joint-re-placement questionnaire,WORQ)评价所有患者手术前后膝关节活动状态,采用工作能力指数评价所有患者术前及术后12个月时的工作能力;对于重返工作岗位的82例患者,比较术前及术后12个月内停止劳动时间,记录患者手术前后劳动等级、工作种类和劳动时长的变化;对于未重返劳动的19例患者,分析其未重返劳动的原因;采用Likert满意度量表评价患者术后满意度。
结果：所有患者获得至少12个月的随访。所有患者VAS由术前的(6.49±0.59)分下降到术后12个月的(1.10±0.43)分,差异有统计学意义(P<0.05);WORQ方面,患者的行走、坐、站立、爬楼梯分别由术前的(1.07±0.35)、(1.05±0.29)、(1.06±0.34)、(1.14±0.42)分提高至术后的(3.00±0.00)、(2.87±0.33)、(2.95±0.21)、(2.95±0.21)分,差异均有统计学意义(P<0.05);所有患者劳动工作指数由术前的1.11±0.46提高至术后12个月的2.99±0.10,差异有统计学意义(P<0.05)。82例术后返回工作岗位患者中,停止劳动时间方面,术前3个月内81例,术后4~6个月1例,停止劳动的患者分别为81、1、0例;术后返回工作岗位为术后3个月内40例、术后4~6个月29例、术后12个月13例;95.1%(78/82)的患者术前从事轻度劳动,85.4%(70/82)的患者术后从事中度劳动;术后12个月所有患者可从事的工作种类和劳动时长均较术前增加。TKA术后未返回工作岗位的19例中,因RA病情控制不佳者7例,膝关节仍感疼痛、肿胀、麻木者5例,已退休2例,其他原因5例。86例(85%)患者对术后劳动能力表示非常满意,8例(8%)表示满意,6例(6%)表示可以接受,1例(1%)表示不满意。
结论：TKA对于RA患者是一个有效的治疗选择,患者在接受TKA后能显著改善膝关节的疼痛及功能活动,并有效提高生活质量和劳动能力。对于未能完全满足康复劳动能力的患者,需加强术后管理和个性化的康复治疗,从而实现最佳的康复效果。 |
| [关键词]:类风湿关节炎 膝关节 关节置换 功能康复 术后康复 |
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| Analysis of labor function rehabilitation after total knee arthroplasty in patients with rheumatoid arthritis |
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Abstract:
Objective To explore the functional rehabilitation of patients with rheumatoid arthritis (RA) after total knee arthroplasty (TKA).
Methods A retrospective analysis was conducted on 101 patients who needed TKA due to rheumatoid arthritis (RA) involving both knees from January 2017 to December 2020,including 16 males and 85 females,aged from 41 to 65 years old with an average of (58.13±5.53) years old;body mass index (BMI) ranged from 16.88 to 33.33 kg·m-2 with an average of (23.16±3.49) kg·m-2;63 patients with grade 1,29 patients with grade 2,and 9 patients with grade 3 according to classification of American Society of Anesthesiologists (ASA). According to the latest follow up results at 12 months after operation,82 patients returned to work and 19 patients did not return to work. Visual analogue scale (VAS) was used to evaluate the degree of pain relief before operation and 12 months after operation,and work,osteoarthritis and joint replacement questionnaire (WORQ) was used to evaluate knee joint activity status of all patients before and after operation,and the working ability index was used to evaluate working ability of all patients before operation and 12 months after operation. For the 82 patients who returned to work,the labor time stopped before operation and within 12 months after operation was compared,and the changes in labor grades,types of work and labor hours of patients before and after operation were recorded. For the 19 patients who did not return to work,the specific reasons for their non-return to work was analyzed;the postoperative satisfaction of patients was evaluated by using Likert satisfaction scale. All patients were followed up for at least 12 months. VAS was decreased from (6.49±0.59) before operation to (1.10±0.43) at 12 months after operation (P<0.05);for WORQ questionnaire survey,scores of walking,sitting posture,standing and stair climbing were increased from (1.07±0.35),(1.05±0.29),(1.06±0.34) and (1.14±0.42) before operation to (3.00±0.00),(2.87±0.33),(2.95±0.21) and (2.95±0.21) after operation,respectively,had statistically significant (P<0.05);the labor work index of all patients increased from 1.11±0.46 before operation to 2.99±0.10 at 12 months after operation,and the difference was statistically significant (P<0.05). Among the 82 patients who returned to work after operation,regarding the time of stopping labor,81 patients stopped working within 3 months before operation,1 patient stopped working for 4 to 6 months after operation,and the number of patients who stopped working was 81,1, and 0 respectively. Forty patients returned to work within 3 months after operation,4 to 6 months after operation for 29 patients,and 12 months after operation for 13 patients. 95.1% (78/82) of patients engaged in light labor before operation,and 85.4% (70/82) of patients engaged in moderate labor after operation. At 12 months after operation,the types of jobs and working hours available to all patients increased compared with those before operation. Among 19 patients who did not return to work after TKA,7 patients had poor control of rheumatoid arthritis,5 patients still felt pain,swelling and numbness on knee joint,2 patients had retired,and 5 patients had other reasons. Eighty-six patients (85%) expressed great satisfaction with the postoperative working ability,8 patients (8%) expressed satisfaction with the postoperative working ability,6 patients (6%) expressed acceptance of postoperative working ability,and 1 patient (1%) expressed dissatisfaction with postoperative working ability.
Conclusion TKA is an effective treatment option for patients with RA. After undergoing TKA,patients could significantly improve pain and functional activities of knee joint,and effectively enhance the quality of life and working ability. For patients whose rehabilitation labor capacity is not fully met,postoperative management and personalized rehabilitation treatment need to be strengthened to achieve the best rehabilitation effect. |
| KEYWORDS:Rheumatoid arthritis Knee joint Joint arthroplasty Functional rehabilitation Postoperative rehabilitation |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 柯彤,郝阳泉,王孟飞,闫宇衡,蔡元真,鲁超.类风湿关节炎患者全膝关节置换术后劳动功能康复情况分析[J].中国骨伤,2025,38(6):594~600 |
| 英文格式: | KE Tong,HAO Yang-quan,WANG Meng-fei,YAN Yu-heng,CAI Yuan-zhen,LU Chao.Analysis of labor function rehabilitation after total knee arthroplasty in patients with rheumatoid arthritis[J].zhongguo gu shang / China J Orthop Trauma ,2025,38(6):594~600 |
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