早期下床活动安全评估系统在关节置换患者中的应用价值:一项随机对照试验研究-现代医学

早期下床活动安全评估系统在关节置换患者中的应用价值:一项随机对照试验研究

单位：1. 南京大学医学院附属鼓楼医院运动医学与成人重建外科, 江苏南京 210044;
2. 南京大学医学院附属鼓楼医院感染管理办公室, 江苏南京 210044

分类号：R473.6

出版年·卷·期（页码）：2025·53·第十期（1625-1630）

摘要：

目的：探究早期下床活动安全评估系统在关节置换患者中的应用价值。方法：本研究为单中心随机对照试验，选取南京大学医学院附属鼓楼医院2021年1月至2022年2月收治的关节置换患者112例，采用信封法随机分成对照组(n=56)与观察组(n=56)。对照组患者常规护理及早期下床活动，观察组患者常规术后护理，并在早期下床活动安全评估系统支持下开展早期下床活动。两组患者均接受干预至出院，对比两组患者术后疼痛评分(VAS评分)、住院时间、术前及术后3个月的髋关节功能(Harris评分)或膝关节功能(HSS评分)、功能独立性量表(FIM)、生活质量指数(QoL-Index)评分、干预满意率。结果：观察组术后第3天的VAS评分低于对照组，住院时间短于对照组(P＜0.05)；术后3个月，观察组Harris评分、HSS评分、FIM评分及QoL-Index评分均优于对照组(P＜0.05)；观察组干预满意率(98.21%)显著高于对照组(85.71%)(P＜0.05)。结论：早期下床活动安全评估系统在髋膝关节置换术患者中应用价值较高，可缓解患者术后疼痛，促进患者髋关节与膝关节功能恢复，患者较为满意，值得应用与推广。

Objective: To investigate the application value of early mobilization safety assessment system in joint replacement patients. Methods: This study was a single center randomized controlled trial. A total of 112 joint replacement patients admitted to Nanjing Drum Tower Hospital from January 2021 to February 2022 were randomly divided into control group(n=56) and observation group(n=56) using the envelope method. The control group received routine nursing care and early mobilization, while the observation group received routine nursing care and early mobilization based on early mobilization safety assessment system. Both groups received interventions until discharge.The postoperative pain(VAS) score, length of hospital stay, Harris Hip score(Harris score), knee joint function(HSS score), functional independence scale(FIM), and quality of life index(QoL) and intervention satisfaction rates were compared between the two groups. Results: VAS score on postoperative day 3 of the observation group was lower than that of the control group, and the length of hospital stay was shorter than that of the control group(P＜0.05). Three months after surgery, Harris score, HSS score, FIM score, and QoL Index score of the observation group were better than those of the control group(P＜0.05). Intervention satisfaction rate of observation group(98.21%) was significantly higher than that in the control group(85.71%)(P<0.05). Conclusion: Early mobilization safety assessment system has high application value in patients undergoing hip and knee replacement surgery, which can alleviate postoperative pain, improve hip and knee joint function, and increase intervention satisfaction rates. Given these benefits, this system merits broader application and clinical adoption.

参考文献：

[1] 曹铁炜,廖晓琴,浦林,等.髋膝关节置换术后病人跌倒恐惧的研究现状[J].护理研究,2021,35(11):1935-1939.
[2] WU K A,KUTZER K M,KUGELMAN D N,et al.Fall prevention after hip and knee arthroplasty[J].Orthop Clin North Am,2025,56(2):121-134.
[3] LIU J,LUTHER L,SMITH N,et al.Revision total knee arthroplasty for catastrophic tibial post failure:rare complication of total knee replacement[J].R I Med J,2023,106(11):44-48.
[4] JÉRÉMIE G,NOGUEIRA G J,STAVROS G,et al.Eosinophilic cellulitis mimicking acute infection after total knee arthroplasty:a case report[J].J Orthop Rep,2024,3(2):100239.
[5] 段丹,宁宁,周宗科,等.全髋、膝关节置换术后患者随访现状的研究进展[J].护士进修杂志,2021,36(18):1664-1667.
[6] 冯安琪,刘楠,朴美花,等.不同剂量地塞米松对老年全髋/膝关节置换术术后认知功能障碍的影响[J].重庆医学,2021,50(7):1170-1173.
[7] CHOI K Y,CHAU W W,LI L M,et al.Improving pain,function and quality of life in end-stage knee osteoarthritis:a patient-preference cohort study on whole-body vibration and exercise as bridging therapies for total knee replacement[J].Arthroplasty,2025,7(1):16.
[8] 杨琳,杨志英.ERAS协会“髋/膝关节置换术围术期加速康复护理共识”解读[J].护理研究,2021,35(11):1881-1885.
[9] 胡晓慧,顾蓥璇,黄林峰,等.亲水性纤维含银敷料改善全髋、膝关节置换术后伤口恢复效果的Meta分析[J].护理研究,2021,35(5):802-807.
[10] 高鸣,郑清源,冀全博,等.晚期强直性脊柱炎已融合髋膝关节置换术后活动度研究[J].中国矫形外科杂志,2021,29(5):476-478.
[11] 余柔,刘进.控制性降压在全髋、膝关节置换术中有效性和安全性的Meta分析[J].中国循证医学杂志,2021,21(1):40-46.
[12] 童培建.髋膝关节置换围手术期加速康复专家共识[J].实用骨科杂志,2021,27(11):961-965.
[13] AL-SHWILLY A A H,AL-SHWILLY H A J,KADHIM H H.Warfarin and bisphosphontes interaction in patients undergoing total knee arthroplasty[J].J Orthop,2024,49:33-37.
[14] 陈洪强,周华,陈德斌,等.应用间隙平衡技术可减少人工全膝关节置换中截骨量及维持下肢力线与屈伸间隙平衡[J].中国组织工程研究,2021,25(30):4828-4832.
[15] 王星,许宏,谢锦伟,等.加速康复外科模式下全髋关节置换术后48 h内出院危险因素分析[J].中华骨与关节外科杂志,2021,14(3):168-174.
[16] 蒋洋洋,吴萍,李燕燕,等.康复锻炼自我效能、锻炼计划对人工髋关节置换术患者健康信念和康复锻炼依从性的链式中介作用[J].现代医学,2023,51(9):1214-1220.
[17] XU S,LIOW M H L,ERIC LIU X,et al.Enhanced recovery after surgery(ERAS) protocol reduces need for patient selection for day surgery total knee arthroplasty[J].J Orthop,2024,49:18-23.
[18] 杨琳,杨志英.基于目标设定理论的动态健康教育在老年髋膝关节置换中的应用[J].实用骨科杂志,2021,27(7):669-672.
[19] 吴晓艳,王锐霞,马丽,等.自我护理能力在全膝关节置换术后患者健康素养与出院准备度中的中介作用[J].现代医学,2023,51(8):1153-1161.
[20] 刘瑾,陶子奇,牛茹.快速康复路径对髋膝关节置换术后并发症的影响[J].国际老年医学杂志,2022,43(1):83-86.
[21] 林延,金花,刘红娟.老年髋膝关节置换术患者术前衰弱风险筛查与住院并发症发生风险相关性分析[J].齐鲁护理杂志,2022,28(8):115-117.
[22] 吴松梅,张艳,陈睿,等.国外髋膝关节置换术后当日出院的护理管理和启示[J].中华现代护理杂志,2022,28(8):981-985.
[23] 吴松梅,罗漫丽,陈睿,等.国外髋膝关节置换日间手术中心工作效率提升策略和启示[J].中国实用护理杂志,2022,38(9):718-721.

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