围手术期护理干预对肌少症合并膝骨关节炎行全膝关节置换术后康复的效果分析

Analysis of the Effect of Perioperative Nursing Interventions on Rehabilitation after Total Knee Arthroplasty in Patients with Sarcopenia and Knee Osteoarthritis

摘要: 膝骨关节炎(knee osteoarthritis, KOA)与肌少症是老年人群高发的共病状态，二者存在双向促进的病理关联，终末期KOA患者行全膝关节置换术(total knee arthroplasty, TKA)后，合并肌少症会显著延缓功能康复、升高并发症风险，是影响手术获益的独立危险因素。本文结合2021~2026年国内外高质量循证证据，系统构建针对肌少症合并KOA患者的“术前预康复–术中保护–术后加速康复–延续性护理”全周期围手术期护理体系，并从肌肉质量与肌力、膝关节功能、躯体活动能力、住院结局及生活质量5个维度分析干预效果。现有证据表明，以渐进抗阻训练、个体化营养支持、多模式疼痛管理为核心的综合护理干预，可使患者术后3个月四肢骨骼肌质量指数提升0.35~0.42 kg/m²，膝伸肌肌力恢复速度提升28%~43%，膝关节Lysholm评分提高10~13分，并发症发生率降低30%~40%。本文同时梳理临床实施中的筛查不足、依从性受限等挑战，提出标准化路径构建、多学科协作等优化策略，为临床骨科护理实践提供循证参考。

Abstract: Knee osteoarthritis (KOA) and sarcopenia are common comorbid conditions among older adults, and they have a mutually reinforcing pathological relationship. For patients with end-stage KOA undergoing total knee arthroplasty (TKA), having sarcopenia can significantly delay functional recovery and increase the risk of complications, making it an independent risk factor that affects surgical outcomes. This paper, based on high-quality domestic and international evidence from 2021 to 2026, systematically constructs a full-cycle perioperative care system for patients with KOA and sarcopenia, covering “preoperative prehabilitation-intraoperative protection-postoperative accelerated recovery-continuous care”, and analyzes intervention effects from five dimensions: muscle mass and strength, knee function, physical activity capacity, hospital outcomes, and quality of life. Current evidence shows that comprehensive care interventions centered on progressive resistance training, individualized nutritional support, and multimodal pain management can increase patients’ limb skeletal muscle mass index by 0.35~0.42 kg/m² three months after surgery, improve knee extensor strength recovery speed by 28%~43%, raise Lysholm knee scores by 10~13 points, and reduce complication rates by 30%~40%. The paper also summarizes challenges in clinical implementation, such as insufficient screening and limited adherence, and proposes optimization strategies like standardized pathway development and multidisciplinary collaboration to provide evidence-based guidance for orthopedic nursing practice.