探討膝骨性關節炎行關節鏡內側皺襞切除術後復健運動之成效

Exploring the Effect of Rehabilitation Exercises after Arthroscopic Excision of Medial Plica in Patients with Knee Osteoarthritis

目的
本研究旨在探討膝關節鏡內側皺襞清除術後早期執行復健運動膝關節功能恢復及日常生活狀況之成效。
方法
本研究以立意取樣方式進行收案，以膝關節炎分期第二、三期併行膝關節鏡內側皺襞清除術後患者為研究對象。採用臺灣南部某區域教學醫院骨科之回溯性資料庫，採用WOMAC評量表結構性問卷方式蒐集資料，進行描述性與推論性統計分析。
結果
研究對象納入共300人，研究結果表明在術後一年WOMAC評分量表在疼痛改善61％，分數7.14降至1.45（p<0.001）；關節僵硬度改善了19％，分數1.46降至1.18（p<0.001）；執行日常生活功能改善61％，分數9.18降至3.62（p<0.001）；膝關節功能總分方面改善65％，分數17.79降到6.24分（p<0.001），皆達顯著意義。結果都明顯優於術前膝關節功能，亦即是本研究中的復健運動能促使退化性膝關節炎術後的疼痛、關節僵硬及執行日常生活功能獲得改善。
結論
膝骨性關節炎患者中，在初級保健健康促進方面可予以行為介入（增強下肢肌肉力量），對術後膝關節功能恢復是有正相關影響。將運動策略納入骨科個案管理，運動鍛煉在手術治療後至少持續6-12個月，可使疼痛緩解、提高日常生活機能的效益。

Purposes
This study investigated the effect of rehabilitation exercise during the early postoperative stage on the recovery of knee joint function and daily life after arthroscopic medial plica resection.
Methods
The study enrolled patients using purposive sampling. Patients with stage II and III knee arthritis who received arthroscopic medial plica resection were included based on the retrospective database of the Department of Orthopedic Surgery of a regional teaching hospital in southern Taiwan. A structured questionnaire of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale was used to collect data and conduct descriptive and inferential statistical analysis.
Results
A total of 300 subjects were included in this study. One year postoperatively, the WOMAC scores showed that pain improved by 61%, with the score decreasing from 7.14 to 1.45 (p<0.001). Joint stiffness improved by 19%, with the score decreasing from 1.46 to 1.18 (p<0.001). Physical function of performing daily activities improved by 61%, with the score decreasing from 9.18 to 3.62 (p<0.001). The total knee function score improved by 65%, decreasing from 17.79 to 6.24 (p<0.001); all improvements were statistically significant. The outcome was significantly better than the preoperative knee function. Therefore, the rehabilitation exercise improved the pain, joint stiffness, and performance of daily living activities after degenerative knee arthritis.
Conclusions
In patients with knee osteoarthritis, behavioral interventions in primary care health promotion (enhancing the muscle strength of the lower extremities) are positively associated with postoperative recovery of knee function. Exercise strategies may be incorporated into orthopedic case management. Postoperative exercise for at least 6-12 months may relieve pain and improve daily living functions.