切换至 "中华医学电子期刊资源库"
高级检索
中华损伤与修复杂志(电子版)

中华损伤与修复杂志(电子版) ›› 2019, Vol. 14 ›› Issue (05) : 330 -338. doi: 10.3877/cma.j.issn.1673-9450.2019.05.003

所属专题： 文献；

论著

人工全膝关节置换术结合加速康复外科理念治疗膝关节骨关节炎的临床效果
杨朝君1, 孙智文1,†(), 张爱民1, 朴俊杰1, 牛爽1, 周琪1, 郑宏梅1   
  1. 1. 024000　赤峰市医院骨关节科
  • 收稿日期:2019-08-26 出版日期:2019-10-01
  • 通信作者: 孙智文
  • 基金资助:
    内蒙古自治区卫生和计划生育委员会科研基金项目(201703214)

Clinical effect of total knee arthroplasty combined with enhanced recovery after surgery on knee osteoarthritis

Zhaojun Yang1, Zhiwen Sun1,†(), Aimin Zhang1, Junjie Piao1, Shuang Niu1, Qi Zhou1, Hongmei Zheng1   

  1. 1. Department of Joint Surgery, Chifeng Municipal Hospital, Chifeng 024000, China
  • Received:2019-08-26 Published:2019-10-01
  • Corresponding author: Zhiwen Sun
  • About author:
    Corresponding author: Sun Zhiwen, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

杨朝君, 孙智文, 张爱民, 朴俊杰, 牛爽, 周琪, 郑宏梅. 人工全膝关节置换术结合加速康复外科理念治疗膝关节骨关节炎的临床效果[J]. 中华损伤与修复杂志(电子版), 2019, 14(05): 330-338.

Zhaojun Yang, Zhiwen Sun, Aimin Zhang, Junjie Piao, Shuang Niu, Qi Zhou, Hongmei Zheng. Clinical effect of total knee arthroplasty combined with enhanced recovery after surgery on knee osteoarthritis[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2019, 14(05): 330-338.

探讨人工全膝关节置换术(TKA)结合加速康复外科(ERAS)理念治疗膝关节骨关节炎(KOA)的疗效。

方法

选取赤峰市医院骨关节科2018年1月至11月收治的KOA患者220例，按随机数字表法分为2组，加速康复组(n＝108)，遵循围手术期应用ERAS理念，严格执行加速康复程序；对照组(n＝112)，沿袭传统手术管理模式。制定相同的出院标准，比较2组患者术后早期疼痛数字评分法(NRS)评分，术后输血率，恶心、呕吐发生率，口渴、饥饿发生率，达到出院标准的时间，术后2周的满意度评分，术后3个月美国特种外科医院(HSS)膝关节评分，术后并发症发生率等。数据比较采用t检验和χ2检验。

结果

术后12、24、48 h,加速康复组术后早期疼痛NRS评分分别为(2.13±1.21)、(2.42±1.11)、(2.83±1.18)分，低于对照组[(3.24±1.45)、(3.35±1.23)、(3.78±1.25)分]，差异均有统计学意义(t＝3.9498、3.7689、3.7088，P＝0.0002、0.0003、0.0004)；加速康复组术后输血率6.5%(7/108)，低于对照组[27.7%(31/112)]，差异有统计学意义(χ2＝17.2887，P<0.05)；加速康复组术后恶心、呕吐发生率为14.8%(16/108)，低于对照组[38.4%(43/112)]，差异有统计学意义(χ2＝15.5741，P<0.05)；加速康复组术后口渴、饥饿发生率为12.0%(13/108)，低于对照组[41.1%(46/112)]，差异有统计学意义(χ2＝23.6163，P<0.05)；加速康复组达到出院标准的时间平均为(2.9±1.3) d，少于对照组[(5.7±1.6) d]，差异有统计学意义(t＝9.1301，P<0.05)；加速康复组术后2周的满意度评分为(9.8±1.2)分，高于对照组[(8.9±1.1)分]，差异有统计学意义(t＝3.7042，P<0.05)；加速康复组、对照组术后3个月HSS膝关节评分分别为(88.2±13.2)、(87.7±16.6)分，2组比较差异无统计学意义(t＝0.1585，P＝0.8744)；加速康复组并发症发生率为2.7%(3/108)，低于对照组[9.8%(10/112)]，差异有统计学意义(t＝4.5779，P＝0.0324)。

结论

采用人工TKA结合ERAS理念治疗KOA，可以减轻术后应激反应，加速患者康复进程，减少手术并发症，缩短住院时间，提高患者满意度，是一种安全、可靠的选择，值得临床推广应用。

关键词: 康复, 关节成形术，置换，膝, 骨关节炎，膝, 围手术期管理
Objective

To evaluate the effect of total knee arthroplasty (TKA) combined with enhanced recovery after surgery (ERAS) in knee osteoarthritis (KOA).

Methods

Two hundred and twenty patients with KOA of the Department of Joint Surgery, Chifeng Municipal Hospital from January 2018 to November 2018 were divided into enhanced recovery group and control group according to the random number table method. The enhanced recovery group(n=108)was applied the ERAS concept and strictly implemented the enhanced recovery program. In contrast group, conventional surgical management mode was followed.Identical discharge standards were established for patients in two groups to evaluate the recovery time.The early postoperative pain numerical rating scale(NRS), blood transfusion rate, nausea and vomiting incidence, thirst, hunger and abdominal distension incidence rate, the time of discharge, the satisfaction of 2 weeks after operation, 3 months′ Hospital for special surgery(HSS) knee score after operation, and the incidence of postoperative complications were compared between the two groups. The data were analyzed by t test and chi-square test.

Results

At 12, 24, and 48 h after operation, the NRS score of patients in the enhanced recovery group were (2.13±1.21), (2.42±1.11), (2.83±1.18) points, which were lower than those in the control group[(3.24±1.45), (3.35±1.23), (3.78±1.25) points], the differences were statistically significant(t=3.9498, 3.7689, 3.7088; P=0.0002, 0.0003, 0.0004); postoperative blood transfusion rate was 6.5%(7/108) in the enhanced recovery group, it was considerably lower than the 27.7%(31/112) in control group, the difference was statistically significant(χ2=17.2887, P<0.05). The incidence of postoperative nausea and vomiting was 14.8%(16/108)in the enhanced recovery group, which was lower than that in the control group[38.4%(43/112)], the difference was statistically significant(χ2=15.5741, P<0.05). The rate of thirst and hunger in the enhanced recovery group was 12.0%(13/108), which was lower than that in the control group[41.1%(46/112)], the difference was statistically significant(χ2=23.6163, P<0.05). The average time for the enhanced recovery group to reach the discharge standard was (2.9±1.3) days, which was shorter than that of the control group[(5.7±1.6) days]. The difference was statistically significant(t=9.1301, P<0.05). The patients′ satisfaction degree at 2 weeks after operation in the enhanced recovery group was(9.8±1.2) points, which was higher than that of the control group[(8.9±1.1) points], the difference was statistically significant(t=3.7042, P<0.05). The HSS knee scores were (88.2±13.2), (87.7±16.6) points in the enhanced recovery group and control group at 3 months postoperatively, there was no significant difference between the two groups(t=0.1585, P=0.8744). The incidence of complications in the enhanced recovery group was 2.7% (3/108), which was lower than that in the control group[9.8% (10/112)], the difference was statistically significant(t=4.5779, P=0.0324).

Conclusions

ERAS in osteoarthritis of knee joint patients with TKA can reducing postoperative stress reaction, accelerate the recovery process of patients, reducing postoperative complications, shorten the lenth of hospital stay and effectively enhance the degree of satisfaction of the patients. It′s a safe and reliable choice and worthy to popularization and application in clinical.

Key words: Rehabilitation, Arthroplasty, replacement, knee, Osteoarthritis, knee, Perioperative management
表1 加速康复组与对照组KOA患者术前一般资料比较
组别 例数 年龄(岁，±s) 性别（例） 手术部位(左侧)[例(%)] 体重指数(kg/m2, ±s) 术前血红蛋白(g/dL, ±s) HSS膝关节评分(分，±s) 术前疼痛NRS评分(分，±s)
男/女
加速康复组 108 62.5±6.6 27/81 58(53.7) 21.2±3.9 11.9±1.3 40.5±5.3 6.3±2.3
对照组 112 61.9±7.2 30/82 63(56.3) 22.1±4.4 12.3±1.4 41.7±6.2 6.6±2.1
t值 ? 0.6436 ? ? 1.0280 1.4053 0.9884 0.6453
χ2值 ? ? 0.0913 0.1440 ? ? ? ?
P值 ? 0.5205 0.7625 0.7043 0.3068 0.1634 0.3257 0.5204
表2 加速康复组与对照组KOA患者术前恶心、呕吐发生风险评估[例(%)]
组别 例数 无 低危 中危 高危
加速康复组 108 13(12.0) 25(23.1) 55(50.9) 15(13.9)
对照组 112 15(13.4) 27(24.1) 58(51.8) 12(10.7)
χ2值 ? 0.0910 0.0280 0.0163 0.5147
P值 ? 0.7630 0.8671 0.8985 0.4731
表3 加速康复组与对照组KOA患者治疗措施比较
项目 加速康复组 对照组
入院前 门诊初筛：诊断明确，近期无感染性疾病发生，无严重心肺疾病病史；完善术前检查：心电图、胸片正常，排除下肢静脉血栓，C反应蛋白检查结果≤正常高值的3倍，经麻醉门诊评估合格的患者，安排入院 直接入院
术前 向患者及其家属就住院时间、治疗目标及出院情况进行详细的术前告知，个性化的心理辅导 术前简单宣教
? 疼痛宣教，向患者及其家属介绍手术方案和康复措施 无疼痛宣教
? 强调主动功能锻炼的重要性，指导患者踝泵练习，直腿抬高练习 ?
? 非甾体类药物超前镇痛 需要时予以非甾体类或阿片类镇痛药
? 营养支持，如无禁忌，术前口服铁剂；术前禁饮2 h，口服碳水化合物400 mL，禁食6 h；识别恶心、呕吐中、高危患者，并于手术当天早晨预防性给予甲氧氯普胺片10 mg加盐酸昂丹司琼片16 mg；手术当天早晨口服枸橼酸莫沙必利片 术前禁饮6 h，禁食12 h
? 术前睡眠障碍者根据情况给予镇静催眠、抗焦虑药物(艾司唑仑片、地西泮片、唑吡坦片) ?
术中 除非蛛网膜下腔麻醉禁忌，常规使用蛛网膜下腔麻醉＋股神经阻滞或收肌管阻滞 由麻醉医师决定具体麻醉方式
? 输入液体加温 室温，输入液体无加温措施
? 术中控制降压，减少使用止血带时间或不使用止血带 全程使用止血带
? 切口关闭前15～20 mg/kg氨甲环酸注射液静脉滴注完毕，关闭切口时氨甲环酸注射液2 g局部关节腔灌注 未使用止血药物
? 采用微创手术技术；切口周围注射镇痛药物罗哌卡因200 mg，地塞米松5 mg，肾上腺素0.2 mL 常规手术技术；局部未使用镇痛药物
? 应用糖皮质激素10 mg 不常规应用地塞米松
? 不常规应用尿管；不常规采用引流管 常规应用尿管；常规放置引流管
术后 控制性输液(<1 500 mL) 静脉输液量>2 000 mL
? 全身麻醉患者清醒后先进饮再进食，细针蛛网膜下腔麻醉者返回病房后可进饮、进食 去枕平卧6 h后进食、水
? 保持头高40°～50°、脚高30°的预防呕吐体位 ?
? 缩短术后监护仪使用时间，尽量减少监护仪对睡眠质量的影响，仍有睡眠障碍者给予镇静催眠药物 常规应用监护仪至术后第1天晨起
? 间断冰敷、抬高患肢 ?
? 麻醉清醒后立即行下肢主动活动并鼓励患者尽早下床 术后1 d患肢主动活动，术后2～3 d下床活动
? 应用糖皮质激素10 mg(术后4～6 h，术后第1天早晨) 术后不使用糖皮质激素
? 使用多模式镇痛，患者自控镇痛，术后静脉滴注、口服非甾体抗炎药，据NRS评分给予阿片类药物，必要时给予镇静、抗抑郁药物 口服非甾体类药物，必要时给予肌内注射阿片类镇痛药物
? 恶心、呕吐患者使用与预防用药不同种类的抗呕吐药物，达到多种药物的联合使用：(1)甲氧氯普胺注射液10～20 mg，3次/d；(2)地塞米松2.5～5 mg，2次/d；(3)氟哌利多1～1.5 mg，2次/d; (4)昂丹司琼4 mg，4次/d，或其他5－羟色胺受体拮抗药 术后恶心、呕吐常规应用甲氧氯普胺注射液10 mg，肌内注射，必要时待患者切口引流量每24 h小于50 mL，拔出引流管；保留尿管2～4 d，训练患者排尿后拔出导尿管
? 继续口服枸橼酸莫沙必利片3 d；继续口服铁剂至出院 未服用相关药物
? 出院后密切随访(主动随访时间：术后1周、2周、1个月、3个月；患者反馈式随访：必要时) 出院后随访(术后2周、1个月、3个月)
表3 加速康复组与对照组KOA患者术后不同时相点疼痛NRS评分比较(分，±s)
组别 例数 术后12 h 术后24 h 术后48 h
加速康复组 108 2.13±1.21 2.42±1.11 2.83±1.18
对照组 112 3.24±1.45 3.35±1.23 3.78±1.25
t值 ? 3.9498 3.7689 3.7088
P值 ? 0.0002 0.0003 0.0004
表4 加速康复组与对照组KOA患者临床疗效的比较
组别 例数 输血率[例(%)] 恶心、呕吐发生率[例(%)] 口渴、饥饿发生率[例(%)] 住院时间(d, ±s) 术后2周满意度(分，±s) 术后3个月HSS膝关节评分(分，±s) 并发症发生生率[例(%)]
加速康复组 108 7(6.5) 16(14.8) 13(12.0) 2.9±1.3 9.8±1.2 88.2±13.2 3(2.7)
对照组 112 31(27.7) 43(38.4) 46(41.1) 5.7±1.6 8.9±1.1 87.7±16.6 10(9.8)
t值 ? ? ? ? 9.1301 3.7042 0.1585 ?
χ2值 ? 17.2887 15.5741 23.6163 ? ? ? 4.5779
P值 ? <0.05 <0.05 <0.05 <0.05 <0.05 0.8744 0.0324
[1]
陆艳红，石晓兵. 膝骨关节炎国内外流行病学研究现状及进展[J]. 中国中医骨伤科杂志，2012, 20(6): 81-84.
[2]
Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation [J]. Br J Anaesth, 1997, 78(5): 606-617.
[3]
中华医学会风湿病学分会. 骨关节炎诊断及治疗指南[J]. 中华风湿病学杂志，2010, 14(6): 416-419.
[4]
Husted H, Hansen HC, Holm G, et al. What determines length of stay after total hip and knee arthroplasty? A nationwide study in Denmark[J]. Arch Orthop Trauma Surg, 2010, 130(2): 263-268.
[5]
Crowe J, Henderson J. Pre-arthroplasty rehabilitation is effective in reducing hospital stay[J]. Can J Occup Ther, 2003, 70(2): 88-96.
[6]
Kearney M, Jennrich MK, Lyons S, et al. Effects of preoperative education on patient outcomes after joint replacement surgery[J]. Orthop Nurs, 2011, 30(6): 391-396.
[7]
Dash SK, Palo N, Arora G, et al. Effects of preoperative walking ability and patient′s surgical education on quality of life and functional outcomes after total knee arthroplasty [J]. Rev Bras Ortop, 2016, 52(4): 435-441.
[8]
Bandura A. Social learning theory of aggression[J]. J Commun, 1978, 28(3): 12-29.
[9]
Bandura A. Self-efficacy: the exercise of control[J]. J Cogn Psychother, 2005, 13(2): 158.
[10]
Mitchell M. The future of surgical nursing and enhanced recovery programmes[J]. Br J Nurs, 2011, 20(16): 978-984.
[11]
周宗科，翁习生，曲铁兵，等. 中国髋、膝关节置换术加速康复--围术期管理策略专家共识[J]. 中华骨与关节外科杂志，2016, 9(1): 1-9.
[12]
Kehlet H, Søballe K. Fast-track hip and knee replacement--what are the issues？[J]. Acta Orthop, 2010, 81(3): 271-272.
[13]
Sculco PK, Pagnano MW. Perioperative solutions for rapid recovery joint arthroplasty: get ahead and stay ahead[J]. J Arthroplasty, 2015, 30(4): 518-520.
[14]
Husted H, Lunn TH, Troelsen A, et al. Why still in hospital after fast-track hip and knee arthroplasty？[J]. Acta Orthop, 2011, 82(6): 679-684.
[15]
Gunaratne R, Pratt DN, Banda J, et al. Patient Dissatisfaction Following Total Knee Arthroplasty: A Systematic Review of the Literature[J]. J Arthroplasty, 2017, 32(12): 3854-3860.
[16]
谢小伟，岳辰，康鹏德，等. 加速康复模式下初次全膝关节置换术后急性疼痛的相关因素分析[J]. 中华骨与关节外科杂志，2016, 9(6): 489-492.
[17]
朱诗白，翟洁，蒋超，等. 膝关节置换围手术期的快速康复措施[J]. 中国组织工程研究，2017, 21(3): 456-463.
[18]
Zhang Y, Tan Z, Liao R, et al. The Prolonged Analgesic Efficacy of an Ultrasound-Guided Single-Shot Adductor Canal Block in Patients Undergoing Total Knee Arthroplasty[J]. Orthopedics, 2018，41(5): e607-e614.
[19]
Jiang X, Wang QQ, Wu CA, et al. Analgesic Efficacy of Adductor Canal Block in Total Knee Arthroplasty: A Meta-analysis and Systematic Review[J]. Orthop Surg, 2016, 8(3): 294-300.
[20]
Kim MK, Moon HY, Ryu CG, et al. The analgesic efficacy of the continuous adductor canal block compared to continuous intravenous fentanyl infusion with a single-shot adductor canal block in total knee arthroplasty: a randomized controlled trial[J]. Korean J Pain, 2019, 32(1): 30-38.
[21]
魏戎，武军龙，刘营杰，等. 全身应用糖皮质激素对全膝关节置换术加速康复影响的系统评价和meta分析[J]. 中国骨与关节外科杂志，2017, 10(2): 117-122.
[22]
Corcoran TB, Myles PS, Forbes AB, et al. The perioperative administration of dexamethasone and infection (PADDI) trial protocol: rationale and design of a pragmatic multicentre non-inferiority study[J]. BMJ Open, 2019, 9(9): e030402.
[23]
De Oliveira GS Jr, Almeida MD, Benzon HT, et al. Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials[J]. Anesthesiology, 2011, 115(3): 575-588.
[24]
吴新民，罗爱伦，田玉科，等. 术后恶心呕吐防治专家意见(2012)[J]. 临床麻醉学杂志，2012, 28(4): 413-416.
[25]
Buckbinder L, Robinson RP. The glucocorticoid receptor: molecular mechanism and new therapeutic opportunities[J]. Curr Drug Targets Inflamm Allergy, 2002, 1(2): 127-136.
[26]
Wu Y, Lu X, Ma Y, et al. Perioperative multiple low-dose Dexamethasones improves postoperative clinical outcomes after Total knee arthroplasty[J]. BMC Musculoskelet Disord, 2018, 19(1): 428.
[27]
Smith MD, McCall J, Plank L, et al. Preoperative carbohydrate treatment for enhancing recovery after elective surgery[J]. Cochrane Database Syst Rev, 2014, (8): CD009161.
[28]
邱维吉，李士通，白刚，等. 健康志愿者液体胃排空时间：核磁共振法确定[J]. 中华麻醉学杂志，2015, 35(1): 16-18.
[29]
DiFronzo LA, Yamin N, Patel K, et al. Benefits of early feeding and early hospital discharge in elderly patients undergoing open colon resection[J]. J Am Coll Surg, 2003, 197(5): 747-752.
[30]
黄小静，彭南海，江志伟. 择期手术患者术前长时间禁食应该被废止[J]. 实用临床医药杂志，2007, 11(9): 21-22.
[31]
Alcelik I, Pollock RD, Sukeik M, et al. A comparison of outcomes with and without a tourniquet in total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. [J]. J Arthroplasty, 2012, 27(3): 331-340.
[32]
Zhang W, Li N, Chen S, et al. The effects of a tourniquet used in total knee arthroplasty: a meta-analysis[J]. J Orthop Surg Res, 2014, 9(1): 13.
[33]
王刚，曹晓瑞，陈晓勇，等. 膝关节置换术中止血带的使用对术后加速康复的影响[J]. 中华骨与关节外科杂志，2017, 10(1): 27-32.
[34]
Huang Z, Ma J, Shen B, et al. General anesthesia: to catheterize or not? A prospective randomized controlled study of patients undergoing total knee arthroplasty[J]. J Arthroplasty, 2015, 30(3): 502-506.
[35]
Zeng WN, Zhou K, Zhou ZK, et al. Comparison between drainage and non-drainage after total hip arthroplasty in Chinese subjects[J]. Orthop Surg, 2014, 6(1): 28-32.
[36]
Quinn M, Bowe A, Galvin R, et al. The use of postoperative suction drainage in total knee arthroplasty: a systematic review[J]. Int Orthop, 2015, 39(4): 653-658.
[37]
Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention[J]. Lancet, 2006，367(9522):1618-1625.
[38]
Jules-Elysee KM, Wilfred SE, Memtsoudis SG, et al. Steroid modulation of cytokine release and desmosine levels in bilateral total knee replacement: a prospective, double-blind, randomized controlled trial[J]. J Bone Joint Surg Am, 2012, 94(23): 2120-2127.
[39]
Karst M, Kegel T, Lukas A, et al. Effect of celecoxib and dexamethasone on postoperative pain after lumbar disc surgery [J]. Neurosurgery, 2003, 53(2): 331-336; discussion 336-337.
[40]
Hval K, Thagaard KS, Schlichting E, et al. The prolonged postoperative analgesic effect when dexamethasone is added to a nonsteroidal antiinflammatory drug (rofecoxib) before breast surgery[J]. Anesth Analg, 2007, 105(2): 481-486.
[41]
徐彬，裴福兴. 髋膝关节置换术加速康复中糖皮质激素的作用[J]. 中华骨与关节外科杂志，2017, 10(3): 259-264.
[42]
杨朝君，孙智文，张爱民，等. 人工股骨头置换术结合快速康复理念治疗高龄不稳定型股骨转子间骨折的临床效果[J/CD]. 中华损伤与修复杂志(电子版), 2018, 13(4): 253-259.
[1] 熊倩, 罗凤. 乳腺癌患者术后康复现状与对策的研究进展[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 372-374.
[2] 闫文, 谢兴文, 顾玉彪, 雷宁波, 马成, 于文霞, 高亚雄, 张磊. 微小RNA与全膝关节置换术后深静脉血栓的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 842-846.
[3] 王宏宇. 固定与活动平台假体在全膝关节置换术中的应用价值[J]. 中华关节外科杂志(电子版), 2023, 17(06): 871-876.
[4] 李善武, 叶永杰, 王兵, 王子呓, 银毅, 孙官军, 张大刚. 胫骨高位截骨与单髁置换的早期疗效比较[J]. 中华关节外科杂志(电子版), 2023, 17(06): 882-888.
[5] 李辉, 吴奇, 张子琦, 张晗, 王仿, 许鹏. 日间全膝关节置换术早期疗效及标准化流程探索[J]. 中华关节外科杂志(电子版), 2023, 17(06): 889-892.
[6] 邓华梅, 袁札根, 曾德荣, 潘珊珊, 张葆青, 欧爱华, 曹学伟. 全膝关节置换术中气压止血带应用效果与影响因素分析[J]. 中华关节外科杂志(电子版), 2023, 17(06): 788-794.
[7] 董红华, 郭艮春, 江磊, 吴雪飞, 马飞翔, 李海凤. 骨科康复一体化模式在踝关节骨折快速康复中的应用[J]. 中华关节外科杂志(电子版), 2023, 17(06): 802-807.
[8] 张思平, 刘伟, 马鹏程. 全膝关节置换术后下肢轻度内翻对线对疗效的影响[J]. 中华关节外科杂志(电子版), 2023, 17(06): 808-817.
[9] 姚轶超, 张麒, 滕海茂, 黄攀, 吴雷涛, 韩哲. 膝关节置换术后恐动症与康复效果及社会支持的相关性[J]. 中华关节外科杂志(电子版), 2023, 17(05): 613-618.
[10] 张中斌, 付琨朋, 朱凯, 张玉, 李华. 胫骨高位截骨术与富血小板血浆治疗膝骨关节炎的疗效[J]. 中华关节外科杂志(电子版), 2023, 17(05): 633-641.
[11] 李雪, 刘文婷, 窦丽婷, 刘叶红. 联合护理在腹腔镜食管裂孔疝修补中的应用效果分析[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 750-754.
[12] 中华医学会骨科分会关节学组. 中国髋、膝关节置换日间手术围手术期管理专家共识[J]. 中华老年骨科与康复电子杂志, 2023, 09(06): 321-332.
[13] 李美娜, 宋艳丽, 杨姗姗, 李聚彩, 罗慧利, 吕杰. 三联预康复策略在退行性脊柱侧弯患者围术期的应用效果[J]. 中华老年骨科与康复电子杂志, 2023, 09(06): 356-364.
[14] 丁晨梦, 胡雪慧, 闫沛, 程乔. 髋部骨折术后患者居家康复体验质性研究的Meta整合[J]. 中华老年骨科与康复电子杂志, 2023, 09(06): 365-372.
[15] 李岩松, 李涛, 张元鸣飞, 李志鹏, 周谋望. 头戴式虚拟现实设备辅助全膝关节置换术后康复的初步研究[J]. 中华临床医师杂志(电子版), 2023, 17(06): 676-681.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号