膝关节置换术后专项护理效果及术后功能影响因素分析

闫楠; 樊昀

doi:10.16766/j.cnki.issn.1674-4152.003696

膝关节置换术后专项护理效果及术后功能影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.003696

闫楠¹,
樊昀^2, ,

1.
阜阳市人民医院骨科(关节及创伤病区)，安徽阜阳 236000
2.
亳州市人民医院风湿免疫科，安徽亳州 236800

基金项目:

安徽省重点研究与开发计划项目 1704f0804039

阜阳市科技计划项目 FK202081030

详细信息

通讯作者:
樊昀，E-mail：13966882318@163.com

中图分类号: R473.6 R687.4
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- 文章访问数: 27
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- 被引次数: 0
出版历程
- 收稿日期: 2024-01-26

Analysis of special nursing effect and postoperative function after total knee arthroplasty

YAN Nan¹,
FAN Yun^{2
, ,}

1.
Department of Orthopedics (Joint and Trauma Ward), Fuyang People' s Hospital, Fuyang, Anhui 236000, China

摘要

摘要: 目的全膝关节置换术(TKA)后患者仍有一定程度的不满意率, 部分术后功能恢复不良，通过评估专项护理对术后恢复的作用，并分析影响术后功能恢复的主要因素，优化术后护理，促进患者膝关节功能恢复，提高满意率。方法回顾性分析2022年2—7月阜阳市人民医院收治的110例膝关节骨性关节炎患者，根据护理方式不同分为专项护理组(52例)和常规护理组(58例)。比较2组末次随访时患者视觉模拟评分(VAS)、美国特种外科医院膝关节评分(HSS评分)、膝关节活动度(ROM)、并发症发生率、护理满意度等。根据HSS评分将患者分为优良组(HSS≥70分)及不良组(HSS<70分)，通过多因素logistic回归分析TKA术后影响膝关节功能的危险因素。结果 (1) 临床效果：专项护理组较常规护理组VAS评分明显降低(2.08±0.97 vs. 3.49±1.10)，术后HSS评分和膝关节ROM明显升高(90.24±9.06 vs. 84.34±7.36；108.80±8.67 vs. 90.45±6.30，P<0.05)；(2)护理效果：专项护理组焦虑评分、患者依从性和护理满意度优于常规护理组，且2组比较差异有统计学意义(P<0.05)；(3)多因素logistic回归显示，护理方式及年龄、术前HSS评分、术后患者依从性、术后SAS评分等均是TKA术后功能恢复的影响因素(P<0.05)。结论专项护理能减轻TKA术后膝关节疼痛，利于膝关节功能恢复；术后护理方式、年龄、术前HSS评分以及术后患者依从性是TKA术后疗效的独立影响因素。
- 膝关节骨性关节炎 /
- 全膝关节置换术 /
- 膝关节功能 /
- 专项护理
Abstract: Objective Despite the presence of patient dissatisfaction following total knee arthroplasty (TKA), some individuals exhibit suboptimal postoperative functional recovery. Through an assessment of the impact of specialized nursing care on postoperative recuperation and an analysis of key factors influencing postoperative functional recovery, it is possible to enhance postoperative care strategies aimed at facilitating the restoration of knee joint function and enhancing patient satisfaction. Methods A retrospective analysis was conducted on 110 patients with knee osteoarthritis admitted to our hospital from February 2022 to July 2022. The patients were divided into a specialized nursing group (52 cases) and a routine nursing group (58 cases) based on different nursing methods. At the last follow-up, comparisons were made between the two groups in terms of visual analogue scale (VAS), hospital for special surgery knee score (HSS score), range of motion (ROM), complication rate, and nursing satisfaction. Patients were further categorized into an excellent group (HSS≥70) or poor group (HSS<70) according to their HSS scores. Multivariate logistic regression analysis was performed to identify risk factors affecting knee joint function after TKA. Results (1) Clinical effect: The VAS score in the specialized nursing group was significantly lower than that in the routine nursing group (2.08±0.97 vs. 3.49±1.10). Additionally, HSS scores and knee ROM showed significant improvement in the specialized nursing group compared to the routine nursing group (90.24±9.06 vs. 84.34±7.36; 108.80±8.67 vs. 90.45±6.30, P<0.05). (2) Nursing effect: The anxiety score, patient compliance, and overall satisfaction with care were better in the specialized nursing group compared to those in the routine nursing group (P<0.05). (3) Multivariate logistic regression results: nursing style age, preoperative HSS score, postoperative patient compliance, and postoperative SAS score all emerged as influential factors for functional recovery after TKA (P<0.05). Conclusion Specialized nursing can alleviate knee pain after TKA surgery and promote knee function recovery. The postoperative nursing method, age, preoperative HSS score, and patient compliance after surgery are independent influencing factors affecting the efficacy of TKA.
- Knee osteoarthritis /
- Total knee replacement /
- Knee joint function /
- Special nursing
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表 1 2组膝关节炎患者的基本资料比较

Table 1. Comparison of baseline demographic data between two groups of patients with knee osteoarthritis

组别	例数	性别(例)		年龄(x±s，岁)	侧别(例)		BMI (x±s)	病程[M(P₂₅, P₇₅)，年]	术前HSS评分(x±s，分)
组别	例数	男性	女性	年龄(x±s，岁)	左	右	BMI (x±s)	病程[M(P₂₅, P₇₅)，年]	术前HSS评分(x±s，分)
常规护理组	58	20	38	65.69±6.86	30	28	26.41±4.18	8(3，10)	57.13±9.73
专项护理组	52	17	35	66.27±6.66	25	27	26.63±3.41	8(3，10)	56.61±10.25
统计量		0.039^a		0.449^b	0.146^a		0.300^b	0.570^c	0.273^b
P值		0.843		0.654	0.702		0.765	0.569	0.785
注：^a为χ²值，^b为t值，^c为Z值。

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表 2 2组膝关节炎患者临床效果指标比较

Table 2. Comparison of clinical effects of two groups of patients with knee arthritis

组别	例数	VAS评分(x±s, 分)	HSS评分(x±s, 分)	ROM (x±s, °)	并发症[例(%)]
常规护理组	58	3.49±1.10	84.34±7.36	90.45±6.30	4(6.90)
专项护理组	52	2.08±0.97	90.24±9.06	108.80±8.67	2(3.84)
统计量		7.095^a	3.764^a	12.574^a	0.080^b
P值		<0.001	<0.001	<0.001	0.777
注：^a为t值，^b为χ²值。

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表 3 2组膝关节炎患者的护理效果指标比较

Table 3. Comparison of nursing effect between two groups of patients with knee arthritis

组别	例数	SAS评分(x±s, 分)	依从性评分(x±s, 分)	护理满意度[例(%)]
常规护理组	58	42.44±5.04	3.01±0.41	49(84.48)
专项护理组	52	37.19±4.72	3.55±0.23	51(98.08)
统计量		5.620^a	8.630^a	4.596^b
P值		<0.001	<0.001	0.032
注：^a为t值，^b为χ²值。

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表 4 膝关节骨性关节炎患者术后功能良好和功能不良组的相关指标比较

Table 4. Comparison of relevant indicators between the well-functioning and poorly functioning groups after TKA

项目	功能良好组(n=91)	功能不良组(n=19)	统计量	P值
性别[例(%)]			0.044^a	0.835
男性	31(34.1)	6(31.6)
女性	60(65.9)	13(68.4)
年龄(x±s，岁)	65.03±6.75	70.34±4.71	3.249^b	0.002
侧别[例(%)]			3.117^a	0.077
左	49(53.8)	6(31.6)
右	42(46.2)	13(68.4)
BMI(x±s)	26.45±3.30	26.82±4.25	0.422^b	0.674
病程[M(P₂₅, P₇₅)，年]	8 (4，10)	7.5 (2，10)	1.576^c	0.115
术前HSS评分(x±s，分)	58.51±11.42	49.09±9.41	3.361^b	0.001
护理锻炼方式[例(%)]			12.442^a	<0.001
常规护理	41(45.1)	17(89.5)
专项护理	50(54.9)	2(10.5)
手术时间(x±s，min)	101.15±15.63	95.53±19.50	1.364^b	0.175
出血量[M(P₂₅, P₇₅), mL]	220(60，300)	180(60，300)	0.889^c	0.374
术后SAS评分(x±s，分)	38.91±5.26	45.01±4.85	4.656^b	<0.001
术后VAS评分(x±s，分)	2.52±1.11	4.25±1.05	6.234^b	<0.001
术后依从性(x±s，分)	3.35±0.22	2.87±0.27	8.307^b	<0.001
术后并发症[例(%)]	4(4.30)	2(10.53)	0.265^a	0.607
注：^a为χ²值，^b为t值，^c为Z值。

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表 5 各变量赋值情况

Table 5. Variable assignment

变量类型	指标	赋值方法
因变量	膝关节术后功能	功能不良=1，功能良好=0
自变量	年龄	≥66岁=1，<66岁=0
	术前HSS评分	≥55分=1，<55分=0
	护理方式	常规护理=1，专项护理=0
	依从性	不依从=1，依从=0
	术后SAS	≥40分=1，<40分=0

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表 6 膝关节术后功能恢复影响因素的多因素logistic回归分析

Table 6. Multivariate logistic regression analysis of factors influencing postoperative knee functional recovery

变量	B	SE	Waldχ²	P值	OR值	95% CI
年龄	0.521	0.194	7.186	0.007	1.683	1.150~2.464
术后SAS	0.324	0.110	8.622	0.003	1.382	1.114~1.716
护理方式	1.003	0.273	13.522	<0.001	2.726	1.597~4.653
依从性	0.743	0.178	17.346	<0.001	2.103	1.482~2.982
术前HSS评分	-0.294	0.121	5.885	0.015	0.745	0.588~0.945

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