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中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2020, Vol. 06 ›› Issue (03) : 153 -158. doi: 10.3877/cma.j.issn.2096-0263.2020.03.006

所属专题： 文献；

关节置换

智能可穿戴方案应用于全膝关节置换术后康复的前瞻性研究
张金陵1, 荣根祥1, 唐智1, 桂斌捷1,†()   
  1. 1. 230022　合肥，安徽医科大学第一附属医院骨科
  • 收稿日期:2020-01-06 出版日期:2020-06-05
  • 通信作者: 桂斌捷
  • 基金资助:
    安徽省公益性研究联动基金项目(1704f0804029)

A prospective study on the application of intelligent wearable program in rehabilitation after total knee arthroplasty

Jinling Zhang1, Genxiang Rong1, Zhi Tang1, Binjie Gui1,†()   

  1. 1. Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
  • Received:2020-01-06 Published:2020-06-05
  • Corresponding author: Binjie Gui
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张金陵, 荣根祥, 唐智, 桂斌捷. 智能可穿戴方案应用于全膝关节置换术后康复的前瞻性研究[J]. 中华老年骨科与康复电子杂志, 2020, 06(03): 153-158.

Jinling Zhang, Genxiang Rong, Zhi Tang, Binjie Gui. A prospective study on the application of intelligent wearable program in rehabilitation after total knee arthroplasty[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2020, 06(03): 153-158.

目的

本研究旨在比较两种不同的膝关节置换术后康复方案，即智能可穿戴方案与传统康复方案的治疗效果。

方法

前瞻性收集安徽医科大学第一附属医院骨科2017年6至2018年12月确诊为单侧膝关节骨关节炎且符合纳入及排除标准的患者90例，随机分成智能可穿戴组和传统康复组。智能可穿戴组入组45例，完成研究40例，年龄（68±7）岁，传统康复组入组45例，完成研究39例，年龄（71±5）岁。智能可穿戴组患者采用智能可穿戴方案完成康复计划；传统康复组患者接受传统定期复查面对面康复指导。随访比较两组患者在术前、术后3个月、术后6个月膝关节功能与生活质量，具体包括起立行走试验（TUG）评测、膝关节损伤与骨关节炎结果评分（KOOS）和膝关节活动度（ROM）测量。

结果

79例患者最终完成随访（智能可穿戴组40名，传统康复组39名），随访时间6~10个月，平均（8.2±2.5）个月。术后3个月，智能可穿戴组患者康复效果优于传统康复组，包括TUG评测（F=5.914，P<0.05）、KOOS评分（F=7.845，P<0.05）和ROM测量（F=18.018、2178、9.532、45.356，P<0.05）。术后6个月智能可穿戴组患者TUG评测优于传统康复组（F=7.845，P<0.05），而两组患者KOOS评分（F=54.744，P>0.05）差异无统计学意义，智能可穿戴组患者ROM测量仅站立位屈膝活动度优于传统康复组（F=5.634，P<0.05）。

结论

智能可穿戴方案指导膝关节置换术后康复，新颖、可行；与术后传统康复方案相比康复效果更好，值得深入研究和尝试。

关键词: 关节成形术，置换，膝, 康复, 远程医疗
Objective

The purpose of this study is to compare two different methods of rehabilitation after total knee arthroplasty, the intelligent wearable project and the traditional way of rehabilitation.

Methods

Ninety patients with knee osteoarthritis were prospectively collected from the department of orthopedics in the first affiliated hospital of AHMU from June 2017 to December 2018. They were randomly divided into study group (smart wearable group) and control group (traditional rehabilitation group). Forty-five cases were enrolled in the study group, and 40 cases completed the study (age 68±7 years), while 45 cases were enrolled in the control group, and 39 cases were completed (age 71±5 years). Patients in smart wearable group completed the rehabilitation plan with intelligent wearable devices; Patients in traditional rehabilitation group received the traditional rehabilitation. Assessments was compared between the two groups at pre-opration, 3 months and 6 months after surgery. Including Time-Up and Go score, KOOS score and the ROM measurement of the knee.

Results

Seventy-nine patients completed the study (40 in smart wearable group and 39 in the control group). There was no significant difference in the general data, TUG score and ROM between the two groups (P>0.05). Three months after the operation, the effect of smart wearable group was better than that of traditional rehabilitation group, including TUG score (F=5.914, P<0.05) and KOOS score (F=7.845, P<0.05), also the ROM was better (F=18.018, 2178, 9.532, 45.356, P<0.05). Six months after the operation, the TUG score (F=7.845, P<0.05) of smart wearable group was better than that in traditional rehabilitation group, but the difference in KOOS score (F=54.744, P>0.05) was not statistically significant. The ROM of smart wearable group was better than that of traditional rehabilitation group (F=5.634, P<0.05) just in standing position and bending.

Conclusion

The results of this study show that the intelligent wearable program is feasible to guide the rehabilitation program after knee replacement and has advantages over the traditional way of rehabilitation, which is worthy of further study.

Key words: Arthroplasty, replacement, knee, Rehabilitation, Telemedicine
表1 研究组与对照组膝关节置换患者一般资料比较表
组别 例数 年龄（岁， ±s） BMI（kg/m2， ±s） 手术时间（min， ±s） 住院时间（d，±s） 性别（女/男） 侧别（右/左） 高血压[例（%）] 糖尿病[例（%）] 冠心病[例（%）]
研究组 40 68±7 28±5 65±11 8.5±2.2 31/9 26/14 25（62.5） 12（30） 5（12.5）
对照组 39 71±5 26±6 69±12 9.1±1.9 30/9 28/11 21（54） 9（23） 7（18）
统计值   t=0.635 t=0.856 t=0.246 t=0.254 χ2=0.105 χ2=0.965 χ2=0.985 χ2=0.458 χ2=0.532
P值   >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
图1~4 NEO-GAIT"勤步"智能可穿戴康复方案
表2 智能可穿戴组与传统康复组TUG评测比较（秒，±s）
组别 例数 术前 术后3个月 术后6个月 F值 P值
智能可穿戴组 40 17.5±2.8 10.8±2.3a 7.5±1.8ab 231.458 0.008
传统康复组 39 16.2±3.2 9.2±3.1a 7.7±2.0ab 324.332 0.012
F值   0.024 5.914 32.726    
P值   0.816 0.003 0.003    
表3 智能可穿戴组与传统康复组KOOS评分比较（分，±s）
组别 例数 术前 术后3个月 术后6个月 F值 P值
智能可穿戴组 40 36±4 84±7a 95±8ab 62.352 0.012
传统康复组 39 38±4 55±5a 85±7ab 21.334 0.025
F值   0.134 7.845 54.744    
P值   0.956 0.014 0.069    
表4 智能可穿戴组与传统康复组膝关节活动度（°，±s）比较
组别 卧位屈膝 F值 P值 坐位屈膝 F值 P值
术前 术后3个月 术后6个月 术前 术后3个月 术后6个月
智能可穿戴组 81±5 100±6a 101±5ab 41.282 0.008 85±6 101±7a 102±5ab 32.164 <0.01
传统康复组 81±6 96±4a 98±4ab 68.856 0.004 89±7 99±5a 100±5ab 275.016 0.001
F值 1.282 18.018 15.402     0.633 2.178 26.744    
P值 0.361 0.012 0.552     0.192 0.045 0.758    
组别 站立屈膝 F值 P值 坐位伸膝 F值 P值
术前 术后3个月 术后6个月 术前 术后3个月 术后6个月
智能可穿戴组 71±4 95±6a 96±8ab 0.633 0.000 25±2 9±2a 8±1ab 18.081 <0.01
传统康复组 68±4 87±6a 94±7ab 69.956 0.004 24±3 8±1a 8±2ab 195.034 0.003
F值 2.564 9.532 5.634     6.322 45.356 0.687    
P值 0.751 0.049 0.036     0.532 0.024 0.675    
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