膝关节置换术患者运动干预的最佳证据总结

doi:10.3761/j.issn.0254-1769.2023.18.014

摘要/Abstract

摘要：

目的检索、评价并总结膝关节置换术患者围手术期运动的最佳证据，为早期开展康复锻炼提供依据。方法计算机检索BMJ Best Practice、UpToDate、PubMed、Cochrane Library、Web of Science、Embase、Scopus、Science Direct、澳大利亚乔安娜布里格斯研究所循证卫生保健中心数据库、中国生物医学文献数据库、中国知网、万方数据库、维普数据库、医脉通、美国运动医学会网站、美国骨科医师协会网站、美国国立临床诊疗指南库、英国国家卫生与临床优化研究所网站中关于膝关节置换术患者运动的证据，检索的文献类型包括临床决策、指南、证据总结、系统评价、专家共识，检索时限为2012年1月—2022年11月，由2名经过循证知识培训的研究者对纳入的文献进行质量评价后，提取、汇总证据。结果共纳入15篇文献，包括临床决策2篇、指南2篇、系统评价7篇、专家共识4篇，从运动获益、多学科团队、注意事项、运动时机、运动类型、运动频率及强度、出院及随访指导7个方面进行整合，共汇总26条证据。结论该研究总结的膝关节置换术患者围手术期运动最佳证据较为科学、全面，医护人员应根据临床情境对证据进行选择，为患者制订安全、科学、个体化的运动计划，以促进患者康复。

关键词: 膝关节置换术, 运动, 锻炼, 康复, 循证护理学

Abstract:

Objective To search，evaluate and summarize the best evidence of perioperative exercise for patients undergoing knee arthroplasty，and to provide a basis for developing early clinical rehabilitation exercise. Methods The databases of BMJ Best Practice，Up To Date，PubMed，Cochrane Library，Web of Science，Embase，Scopus，Science Direct，JBI EBP Database，SinoMed，CNKI，Wanfang，VIP，Medlive，American College of Sports Medicine，American Academy of Orthopaedic Surgeons，National Guideline Clearing House of the United States，National Institute for Health and Care Excellence of the United Kingdom and other databases were searched for evidence of sports in patients undergoing knee arthroplasty. Literature were searched，including clinical decision-making，guidelines，evidence summaries，systematic reviews and expert consensuses. The retrieval time limit was from January 2012 to November 2022. 2 researchers who had received training of evidence-based knowledge evaluated the quality of the included literature，and extracted and summarized the evidence. Results A total of 15 articles were involved，including 2 clinical decision papers，2 guidelines，7 systematic reviews and 4 expert consensuses. 26 pieces of evidence of the perioperative exercise of patients undergoing knee arthroplasty were summarized from 7 aspects，including exercise benefits，multidisciplinary teams，matters for attention，exercise timing，exercise type，exercise frequency and intensity，discharge and follow-up guidance. Conclusion The best evidence of perioperative exercise of patients with knee arthroplasty summarized in this study is more scientific and comprehensive. In the future clinical application，we should select evidence based on the real clinical situation，and make a safe，scientific and individualized exercise plan for patients to promote their rehabilitation.

Key words: Knee Arthroplasty, Movement, Exercise, Rehabilitation, Evidence-Based Nursing

黄娅若, 李彦林, 杨琼君, 胡瑞, 官雪燕, 于文帆, 谭亚鹏, 田莹. 膝关节置换术患者运动干预的最佳证据总结[J]. 中华护理杂志, 2023, 58(18): 2265-2272.

HUANG Yaruo, LI Yanlin, YANG Qiongjun, HU Rui, GUAN Xueyan, YU Wenfan, TAN Yapeng, TIAN Ying. Evidence summary of exercise intervention in patients undergoing knee arthroplasty[J]. Chinese Journal of Nursing, 2023, 58(18): 2265-2272.

图/表 4

图1 文献筛选流程图注：JBI为乔安娜布里格斯研究所；NGC为美国国立指南库；NICE为英国国家卫生与临床优化研究所；AAOS为美国骨科医师协会；ACSM为美国运动医学会。

Figure 1 Flow chart of literature screening

表1 纳入文献的一般特征（n=15）

Table 1 Characteristics of included literature（n=15）

表2 纳入指南的质量评价结果（n=2）

Table 2 The quality of the included guidelines（n=2）

表3 膝关节置换术患者运动干预的最佳证据总结

Table 3 Evidence summary of exercise intervention in patients undergoing TKA

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