术后一体化康复模式在老年膝关节置换术后的应用效果

The Application Effect of Postoperative Integrated Rehabilitation Mode in Elderly Patients after Knee Joint Replacement Surgery

摘要: 目的：本研究旨在评估术后一体化康复模式在老年患者膝关节置换术后的有效性，并与传统的常规康复模式进行比较，以探究其对疼痛管理、功能恢复和生理指标改善的影响。方法：采用前瞻性随机对照研究，将2024年5月至2025年3月于我院行TKA的83例老年患者分为两组。对照组(n = 43)接受术后常规康复，实验组(n = 40)接受术后一体化康复。两组术后均采用地佐辛静脉自控镇痛(PCIA)。比较两组患者术后72小时内的生理指标(白细胞计数、C反应蛋白、D-二聚体)、功能恢复指标(首次下床时间、首次屈膝90˚时间、HSS评分)及并发症发生率。结果：实验组术后首次下床时间(22.3 ± 4.0 h vs 28.5 ± 4.3 h)、首次屈膝90˚时间(52.3 ± 6.4 h vs 72.1 ± 8.7 h)均显著早于对照组(P < 0.01)。术后72 h，实验组HSS评分(82.1 ± 4.8分 vs 70.5 ± 5.2分)显著高于对照组，而C反应蛋白(15.7 ± 8.9 mg/L vs 35.1 ± 11.2 mg/L)与D-二聚体(0.92 ± 0.28 μg/mL vs 1.38 ± 0.39 μg/mL)水平显著低于对照组(P < 0.01)。实验组总并发症发生率低于对照组(17.5% vs 41.9%, P < 0.01)。结论：在标准地佐辛镇痛保障下，术后一体化康复模式能安全、有效地促进老年TKA患者早期功能恢复，减轻炎症反应，降低并发症风险。

Abstract: Objective: This study aimed to evaluate the effectiveness of a postoperative integrated rehabilitation model in elderly patients after knee replacement and compare it with the traditional conventional rehabilitation model to explore its impact on pain management, functional recovery, and improvement of physiological indicators. Method: A prospective randomized controlled study was used to divide 83 elderly patients who underwent TKA in our hospital from May 2024 to March 2025 into two groups. The control group (n = 43) received postoperative routine rehabilitation, and the experimental group (n = 40) received postoperative integrated rehabilitation. Dezocine patient-controlled intravenous analgesia (PCIA) was used in both groups postoperatively to compare the physiological indicators (white blood cell count, C-reactive protein, D-dimer), functional recovery indicators (first time out of bed, first knee flexion time of 90˚, HSS score) and complication rates within 72 hours after surgery between the two groups of patients. Result: The time to get out of bed for the first time after surgery in the experimental group (22.3 ± 4.0 h vs 28.5 ± 4.3 h) and the time to bend the knee to 90˚ for the first time (52.3 ± 6.4 h vs 72.1 ± 8.7 h) were significantly earlier than those in the control group (P < 0.01). 72 hours after surgery, the HSS score of the experimental group (82.1 ± 4.8 points vs 70.5 ± 5.2 points) was significantly higher than that of the control group, while the C-reactive protein (15.7 ± 8.9 mg/L vs 35.1 ± 11.2 mg/L) and D-dimer (0.92 ± 0.28 μg/mL vs 1.38 ± 0.39 μg/mL) levels were significantly lower than those in the control group (P < 0.01). The total complication rate in the experimental group was lower than that in the control group (17.5% vs 41.9%, P < 0.01). Conclusion: Under the protection of standard dezocine analgesia, the postoperative integrated rehabilitation model can safely and effectively promote early functional recovery in elderly TKA patients, reduce inflammatory reactions, and reduce the risk of complications.