虚拟现实技术对全膝关节置换术后功能恢复及心理改善的作用

摘要

Background: With the aging of population in China, more elderly patients suffered from knee osteoarthritis (OA).Total knee arthroplasty(TKA)is an effective method for moderate and severe knee OA.Objective:To investigate the effect of virtual reality on knee joint rehabilitation and psychological status in the early stage of rehabilitation training after TKA.Methods:A total of 120 patients scheduled for unilateral TKA between March 2015 and October 2016 were enrolled in this prospective study.They were assigned to control group and experimental group according to random number table (n=60).All the patients received early-stage rehabilitation training after operation.In addition,virtual reality was used in the intermission of the rehabilitation in the experimental group.The time of the first active flexion of 45 and 90 degrees,NRS score,range of motion(ROM)of the knee,functional improvement,rehabilitation enthusiasm and quality of life were com-pared between two groups.Results:The first active flexion of 45 and 90 degrees in the experimental group was significantly earlier than those in the control group(P<0.05).NRS score in the experimental group was significantly lower than that in the control group (P<0.05). ROM and HSS score on Day 14 postoperatively were significantly higher than preoperative ones in both groups(P<0.05),moreover,the two parameters in the experimental group were significantly higher than those in the control group (P<0.05).The scores of rehabilitation needs, coordination, compliance, coping with setbacks and en-couragement from nursing staff in the experimental group were significantly higher than those in the control group (P<0.05).Both physiological and psychological scores in the SF-12 scale at hospital discharge were significantly increased in both groups as compared with preoperative ones(P<0.05),and the scores in the experimental group were significantly high-er than those in the control group(P<0.05).Conclusions:The application of virtual reality can alleviate the pain,improve the recovery rate,promote the functional recovery of the knee in the early-stage rehabilitation training after TKA.%背景:随着中国老龄化的日益严重,膝骨关节炎(osteoarthritis,OA)患者越来越多,全膝关节置换术(total knee arthroplasty,TKA)是目前治疗中重度膝OA的有效方法.目的:探析TKA术后早期阶段式康复训练中应用虚拟现实技术对其膝关节恢复、心理状态的改善效果及意义.方法:前瞻性选取2015年3月至2016年10月行单侧TKA的120例患者,采用随机数表法,根据术后康复训练模式不同将其分为2组,每组60例,对照组术后早期行阶段式康复训练,试验组在分阶段康复训练间歇期运用虚拟现实技术指导下的康复锻炼,对比两组患者初次主动屈曲达45°和90°的时间及NRS评分、膝关节活动度和功能改善情况、康复积极性以及生活质量.结果:试验组患者初次主动屈曲达45°、90°的时间和NRS评分明显小于对照组(P<0.05);两组患者术后14 d的ROM、HSS评分均明显高于术前(P<0.05),试验组术后14 d的ROM、HSS评分均明显高于对照组(P<0.05);试验组患者术后康复需求、配合、依从性和遇挫折后良好情绪、家属及护理人员鼓励作用评分均明显高于对照组(P<0.05);两组患者出院时SF-12量表中生理总评分、心理总得分较术前均明显提高(P<0.05),出院时试验组两项评分均明显高于对照组(P<0.05).结论:早期阶段式康复训练中应用虚拟现实技术可减轻TKA患者早期疼痛,提高康复速度,促进膝关节功能的恢复,可作为术后有效的辅助康复手段,应用前景广阔.