陳昭瑩2006-07-262018-07-082006-07-262018-07-082002http://ntur.lib.ntu.edu.tw//handle/246246/25618http://ntur.lib.ntu.edu.tw/bitstream/246246/25618/1/902314B002381.pdfThe goals of total knee arthrolplasty are to relief the knee pain and restoration the normal knee function. The purposes of this study are: 1. To develop an home exercise protocol for training of knee range of motion before TKR. 2. To evaluate the training effect of home exercise protocol for OA patients before surgery. 3 .To investigate the motor performance (propriception, strength, range of motion, function and gait) of knee of these patients with and without home exercise before TKR and to compare the difference between these two group. The subjects are patients with osteoarthritic knee planing to receiving total knee arthroplasty in a medical center. 30 patients without home exercise and 30 with home exercise will be recruited. The initial evaluation will be arranged in orthopedic clinics when the doctor and patient decide to have the operation. The tests include knee strength, range of motion of knee, functional status, self-paced walk and timed stair-climbing test. The patients will be evaluated with the same program again, on the day before operation to show the change in a 1-month interval. At 2-4 months post-operation, the patients were evaluated for the third time to investigate the difference of the motor performance between these two groups. There were 26 cases and 19 eases complete these three trials of evaluation. The group of home exercise showed significant increasing in the range of motion of knee flexion and decreasing in extension deficits and the pain level. In the aspect of functional evaluation, no significant differences were noted between these two groups. The results of this study revealed that home exercise could improve the range of motion of knee joint, and the pain level during motion for patients with TKR. The pr-operative home exercise program is recommended for the patients planned to receive operation with TKR.人工膝關節置換手術後，讓病人恢復沒有疼痛，正常的關節活動與功能是為高目標。本研究計畫之目的1 . 設計出接受膝關節置換手術前病．忽之居家物理治療運動。2 ．了解接受一個月居家運動後，膝關節肌力、關節活動度、功能狀況及步態之情況；與無接受居家運動病患比較，而了解居家運動對退化性關節炎病息之療效。3 ．比較術前接受居家運動與傳統未接受居家運動病人，在手術後2 一4 個月，其膝關節肌力、關節活動度、功能恢復狀況及步態的改變情形。本研究以在台大醫院骨科門診且願意接受膝關節置換手術之退化性膝關節病息，在門診時由醫師告知，願意接受檢查者為對象，預計60 位。並安排初次評估一前基礎值。測試內容包括：肌力、關節活動度、功能狀況、步行速度與上下樓梯測試。同時，進行文獻回顧及專家會議，設計居家物理治療運動。本研究進行之前4 個月，所收集之前30 名病人，為控制組，依照目前之醫療程序，決定開刀復送健保局審查，健保核准後，通知病人開刀，一般等候時間為3 一4 週。在住院開刀前再接受第二次評估。並於病人開刀後2 一4 個月間進行第三次評估。本研究的第二部份，於第五個月復開始收集復30 名病人，於門診初次評估後，教導居家運動， 為居家運動組，並於等候健保送審開刀的一個月中，執行居家運動計畫。在住院開刀前接受第二次評估。並於病人開刀後2 一4 個月間進行第三次評估。比較兩組病人第二次評估之差異，檢測居家物理治療之療效。最後，比較第三次評估之差異，以了解手術前居家運動對手術後病人膝關節角度與功能之影響。本研究共有26 名控制組與19 名居家運動組完成三次測試，結果發現居家運動組之膝關節彎曲角度明顯大於控制組，而且運動中之疼痛分數也比控制組明顯下降。在膝關節伸直缺失方面，居家運動組則明顯小於控制組。在徒手肌力評估方面，則發現居家運動組於手術後均達4 分以上之等級，但是控制組仍然有將近五分之一到四分之一的病例是4 分以下的肌力等級。在膝關節功能評估分數、步行時間與上下樓梯時間方面則在兩組間無明顯差異。手術前居家運動之給予可以改善手術後病人之膝關節狀況，主要以膝關節彎曲角度、伸直角度、肌力與運動中之疼痛分數為主。手術前居家運動並不會增加醫療支出，但是需要跨科之合作，如果臨床上可以推廣，相信可以幫助病人在手術前讓膝關節的活動度、肌力與疼痛狀況維持在最佳狀況，而讓手術後之功能恢復更好，讓病人更滿意。application/pdf616651 bytesapplication/pdfzh-TW國立臺灣大學醫學院物理治療學系暨研究所journal articlehttp://ntur.lib.ntu.edu.tw/bitstream/246246/25618/1/902314B002381.pdf