术后早期系统康复治疗对高龄半髋置换术患者的影响
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摘要
目的探讨术后早期系统康复治疗对高龄半髋置换术(HA)患者的影响。方法将76例高龄HA患者(年龄>80岁)随机分为实验组(术后早期系统康复治疗)与对照组(传统康复治疗),每组38例。比较2组患者术后1、3、6个月及1年的患髋疼痛评分(VAS评分)、患髋临床功能评定(Harris评分)、影像学评价、并发症发生情况和生活质量评分(SF-36量表)。结果所有患者均未出现失访的情况,实验组术后1、3、6个月及1年的患髋疼痛VAS评分均低于对照组,但差异无统计学意义(P>0. 05)。2组术后1、3个月的Harris评分比较,差异有统计学意义(P <0. 05);实验组术后6个月及1年的Harris评分高于对照组,但差异无统计学意义(P> 0. 05)。2组术前的股骨皮质指数、CC值比较,差异无统计学意义(P> 0. 05)。2组假体柄髓腔填充率比较,差异也无统计学意义(P> 0. 05)。术后3～5 d假体柄髓腔填充率与置换后1、3、6个月及1年内的X线片相比,2组均无明显下沉(<2 mm),延髓的外展角位置未发生明显改变,白髓和股骨柄周围无明显的线条,无假体骨折、周围骨折和松动。对照组并发症发生率为34. 20%,高于实验组的13. 20%,差异有统计学意义(P <0. 05)。实验组与对照组术前的SF-36总分分别为(407. 28±25. 71)、(412. 13±19. 65)分,差异无统计学意义(P> 0. 05);实验组术后3个月的SF-36总分为(682. 46±35. 21)分,对照组为(624. 59±42. 76)分,均显著高于各组术前评分(P <0. 01),且实验组显著高于对照组(P <0. 01)。结论早期全身康复能促进患髋的功能恢复,提高老年患者的生活质量,减少术后并发症的发生,缩短住院时间,减轻经济负担。
Objective To study the effect of early systemic rehabilitation therapy in elderly patients after hemiarthroplasty. Methods A total of 76 elderly patients( aged over 80 years old)with semi-hip replacement surgery in our hospital were randomly divided into experimental group( early postoperative systematic rehabilitation therapy after surgery) and control group( the conventional rehabilitation after surgery),with 38 patients in each group. visual analogue scale score( VAS score),hip functional assessment( Harris score),imaging evaluation,complication occurrence and quality of life score( SF-36 scale) at 1,3,6 months and 1 year of follow-up in the two groups were compared. Results No patients withdrew the follow-up. VAS scores in the experimental group at 1,3,6 months and 1 year of follow-up were lower than that in the control group,but no difference was observed( P > 0. 05). Significant differences in Harris scores between the two groups at 1 and 3 months after surgery were seen( P < 0. 05). Harris scores at 6 months and 1 year after surgery in the experimental group were significantly higher than that in the control group,but there was no statistically significant difference between the two groups( P > 0. 05). The preoperative cortical index,filling rate of prosthesis pulp cavity and CC values of two groups showed no statistically significant differences( P > 0. 05). Filling of prosthesis pulp cavity after 3 to 5 days of the two groups had no obvious sink( < 2 mm) when compared with 1,3,6 months and 1 year after the replacement of X-ray plain film. The outreach angle of pulp angular position showed no change,white pulp and femoral components surrounding had no bright line,no prosthetic fractures,peripheral fractures and looseness were found. The incidence of complications in the experimental group was higher than that in the control group( 34. 2% vs. 13. 2%,P < 0. 05). Preoperative total scores of SF-36 scale in the experimental group and control group were( 407. 28 ± 25. 71),( 412. 13 ± 19. 65),showing no differences( P >0. 05),and postoperative total scores of SF-36 scale were( 682. 46 ± 35. 21),( 624. 59 ± 42. 76),respectively,at 3 month after operation,which were higher than preoperation( P < 0. 01),and experimental group was higher than the control group( P < 0. 01). Conclusion Early systemic rehabilitation can promote the recovery of hip function,improve the quality of life of elderly patients,reduce the incidence of postoperative complications,shorten the length of hospital stay,and reduce the economic burden.
Objective To study the effect of early systemic rehabilitation therapy in elderly patients after hemiarthroplasty. Methods A total of 76 elderly patients( aged over 80 years old)with semi-hip replacement surgery in our hospital were randomly divided into experimental group( early postoperative systematic rehabilitation therapy after surgery) and control group( the conventional rehabilitation after surgery),with 38 patients in each group. visual analogue scale score( VAS score),hip functional assessment( Harris score),imaging evaluation,complication occurrence and quality of life score( SF-36 scale) at 1,3,6 months and 1 year of follow-up in the two groups were compared. Results No patients withdrew the follow-up. VAS scores in the experimental group at 1,3,6 months and 1 year of follow-up were lower than that in the control group,but no difference was observed( P > 0. 05). Significant differences in Harris scores between the two groups at 1 and 3 months after surgery were seen( P < 0. 05). Harris scores at 6 months and 1 year after surgery in the experimental group were significantly higher than that in the control group,but there was no statistically significant difference between the two groups( P > 0. 05). The preoperative cortical index,filling rate of prosthesis pulp cavity and CC values of two groups showed no statistically significant differences( P > 0. 05). Filling of prosthesis pulp cavity after 3 to 5 days of the two groups had no obvious sink( < 2 mm) when compared with 1,3,6 months and 1 year after the replacement of X-ray plain film. The outreach angle of pulp angular position showed no change,white pulp and femoral components surrounding had no bright line,no prosthetic fractures,peripheral fractures and looseness were found. The incidence of complications in the experimental group was higher than that in the control group( 34. 2% vs. 13. 2%,P < 0. 05). Preoperative total scores of SF-36 scale in the experimental group and control group were( 407. 28 ± 25. 71),( 412. 13 ± 19. 65),showing no differences( P >0. 05),and postoperative total scores of SF-36 scale were( 682. 46 ± 35. 21),( 624. 59 ± 42. 76),respectively,at 3 month after operation,which were higher than preoperation( P < 0. 01),and experimental group was higher than the control group( P < 0. 01). Conclusion Early systemic rehabilitation can promote the recovery of hip function,improve the quality of life of elderly patients,reduce the incidence of postoperative complications,shorten the length of hospital stay,and reduce the economic burden.
引文
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[12]叶恒.全髋置换术与半髋置换术治疗对老年股骨颈骨折患者关节功能早期恢复的影响[J].吉林医学,2017,38(6):1040-1042.
[13]郑典涛. 4周与12周完全负重对生物型全髋关节置换术后稳定及疗效的对照研究[D].南宁:广西医科大学,2016.
[14]乔永杰,花晨朝,王锐,等.全髋置换术与半髋置换术治疗老年移位型股骨颈骨折的Meta分析[J].中国矫形外科杂志,2016,24(16):1471-1477.
[15]赵红莲,刘晓丽,冯向春,等.全髋关节置换术和半髋关节置换术治疗老年股骨颈骨折的疗效比较[J].中国老年学杂志,2014,34(23):6671-6672.
[16]李龙.全髋置换术与半髋关节置换术治疗老年股骨颈骨折疗效对比[J].河北医学,2013,19(4):498-500.
[17]李云.金属大头全髋关节置换术和半髋关节置换术治疗老年人股骨颈骨折的近期疗效比较[J].名医,2018(6):34-34.
[2] Li J,Xiao J,Zhang Z,et al. A Novel Fast Mobile-Window Small Incision Technique for Hip Arthroplasty in the Elderly and Comparison with Conventional Incision[J]. Med Sci Monit,2017,23:3303-3310.
[3] Ottink K,Barnaart L,Westerbeek R,et al. Survival,clinical and radiological outcome of the Zweymüller SL/Bicon-Plus total hip arthroplasty:a 15-year follow-up study[J]. Hip Int,2015,25(3):204-208.
[4]邱树茂,游辉,黄海玲.全髋置换术与半髋置换术治疗股骨颈骨折的对照研究[J].基层医学论坛,2018,22(17):2450-2451.
[5]居建文,叶峥,朱剑,等.全髋与半髋置换术对老年股骨颈骨折患者髋关节功能恢复的影响[J].中国实用医药,2017,12(28):74-75.
[6]潘伟坤.全髋置换术及半髋置换术应用在老年股骨颈骨折治疗中的效果对比[J].中外医学研究,2017,15(29):169-170.
[7]魏星,李祖高,陈健.全髋与半髋置换术对老年股骨颈骨折患者髋关节功能恢复的影响[J].当代医学,2018,24(2):121-122.
[8] Bradley B M,Moul S J,Doyle F J,et al. Return to Sporting Activity After Total Hip Arthroplasty-A Survey of Members of the British Hip Society[J]. J Arthroplasty,2017,32(3):898-902.
[9]王林鹰.老年股骨颈骨折患者行全髋或半髋置换术临床分析[J].基层医学论坛,2016,20(28):3950-3951.
[10] Malhotra R,Babhulkar S,Sanjib K B,et al. Thromboprophylaxis with dabigatran after total hip arthroplasty in Indian patients:A subanalysis of a double-blind,double-dummy,randomized RE-NOVATEⅡstudy[J]. Asian J Surg,2017,40(2):145-151.
[11]刘红卫.人工全髋关节置换术与半髋置换术在老年股骨颈骨折治疗中的疗效研究[J].临床医学研究与实践,2018,3(2):104-105,142.
[12]叶恒.全髋置换术与半髋置换术治疗对老年股骨颈骨折患者关节功能早期恢复的影响[J].吉林医学,2017,38(6):1040-1042.
[13]郑典涛. 4周与12周完全负重对生物型全髋关节置换术后稳定及疗效的对照研究[D].南宁:广西医科大学,2016.
[14]乔永杰,花晨朝,王锐,等.全髋置换术与半髋置换术治疗老年移位型股骨颈骨折的Meta分析[J].中国矫形外科杂志,2016,24(16):1471-1477.
[15]赵红莲,刘晓丽,冯向春,等.全髋关节置换术和半髋关节置换术治疗老年股骨颈骨折的疗效比较[J].中国老年学杂志,2014,34(23):6671-6672.
[16]李龙.全髋置换术与半髋关节置换术治疗老年股骨颈骨折疗效对比[J].河北医学,2013,19(4):498-500.
[17]李云.金属大头全髋关节置换术和半髋关节置换术治疗老年人股骨颈骨折的近期疗效比较[J].名医,2018(6):34-34.