快速康复对老年股骨颈骨折全髋关节置换患者髋关节功能的影响
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摘要
目的研究快速康复对老年股骨颈骨折(FNF)全髋关节置换(THA)患者髋关节功能的影响。方法 2014年7月—2017年6月成都医学院第一附属医院骨科治疗128例老年FNF患者。其中男性72例,女性56例;年龄62～83岁,平均71.44岁。致伤原因:跌倒伤75例,坠落伤26例,道路交通伤22例,其他5例。依据随机数字表法分为快速康复组(n=64)和对照组(n=64)。术后,对照组采用常规康复方案,快速康复组采用快速康复方案,内容包括:制定快速康复方案、康复宣教、疼痛管理、康复锻炼。观察两组康复后6、12个月髋关节功能,日常生活能力及生存质量评分,血清缓激肽(BK)、前列腺素E_2(PGE_2)、5-羟色胺(5-HT)、脑内神经肽Y(NPY)等疼痛因子,首次下床时间,术后住院时间,住院费用以及术后并发症。结果康复6、12个月,快速康复组Harris评分、日常生活能力量表(ADL)评分、生存质量量表(WHO-QOL)评分均高于对照组,BK、PGE_2、5-HT、NPY等疼痛因子水平均低于对照组(P<0.05)。快速康复组首次下床时间、术后住院时间及住院费用均少于对照组(P<0.05)。快速康复组术后并发症发生率(7.81%)低于对照组(59.38%,P<0.05)。结论快速康复可快速重建老年患者FNF行THA后髋关节功能,提高日常生活能力及生存质量,抑制释放疼痛因子,且康复快,值得临床应用。
Objective To study the effect of rapid rehabilitation on hip joint function in elderly femoral neck fracture patients with total hip replacement(THA). Methods A total of 128 femoral neck fracture patients in our hospital from Jul. 2014 to Jun. 2017 were included in this study. There were 72 males and 56 females. The average age was 71.44(62-83) years. The causes of injury included fall injury in 75 cases,falling injury in 26 cases,traffic injury in 22 cases,and other 5 cases. They were divided into rapid rehabilitation group(n=64) and control group(n=64) using the random number table method. After operation,the conventional rehabilitation program was used in the control group and the rapid rehabilitation program was used in the rapid rehabilitation group. The contents included development of rapid rehabilitation program and rehabilitation education,pain management and rehabilitation exercise. Hip joint function,activity of daily living(ADL) and quality of life score(WHO-QOL),and the levels of pain factors such as serum bradykinin(BK),prostaglandin E_2(PGE_2),5-hydroxytryptamine(5-HT),neuropeptide Y(NPY) 6,12 months after rehabilitation in the two groups were observed. The first time for getting out of bed,postoperative hospital stay,hospitalization expenses,postoperative complications in the two groups were observed. Results At 6,12 months after rehabilitation,the Harris score,ADL score,WHO-QOL score in rapid rehabilitation group were higher than those in control group(P<0.05). Levels of serum BK,PGE2,5-HT,NPY in rapid rehabilitation group were lower than those in control group(P<0.05). The first time for getting out of bed,postoperative hospital stay,hospitalization expenses in rapid rehabilitation group were less than those in control group(P<0.05). The incidence of postoperative complications in rapid rehabilitation group(7.81%) was lower than that in control group(59.38%,P<0.05). Conclusion Rapid rehabilitation can quickly reconstruct the hip joint function of elderly femoral neck fracture patients with THA,improve the ability of daily life and quality of life,inhibit the release of pain factors,and promote rapid recovery,which is worthy of clinical application.
Objective To study the effect of rapid rehabilitation on hip joint function in elderly femoral neck fracture patients with total hip replacement(THA). Methods A total of 128 femoral neck fracture patients in our hospital from Jul. 2014 to Jun. 2017 were included in this study. There were 72 males and 56 females. The average age was 71.44(62-83) years. The causes of injury included fall injury in 75 cases,falling injury in 26 cases,traffic injury in 22 cases,and other 5 cases. They were divided into rapid rehabilitation group(n=64) and control group(n=64) using the random number table method. After operation,the conventional rehabilitation program was used in the control group and the rapid rehabilitation program was used in the rapid rehabilitation group. The contents included development of rapid rehabilitation program and rehabilitation education,pain management and rehabilitation exercise. Hip joint function,activity of daily living(ADL) and quality of life score(WHO-QOL),and the levels of pain factors such as serum bradykinin(BK),prostaglandin E_2(PGE_2),5-hydroxytryptamine(5-HT),neuropeptide Y(NPY) 6,12 months after rehabilitation in the two groups were observed. The first time for getting out of bed,postoperative hospital stay,hospitalization expenses,postoperative complications in the two groups were observed. Results At 6,12 months after rehabilitation,the Harris score,ADL score,WHO-QOL score in rapid rehabilitation group were higher than those in control group(P<0.05). Levels of serum BK,PGE2,5-HT,NPY in rapid rehabilitation group were lower than those in control group(P<0.05). The first time for getting out of bed,postoperative hospital stay,hospitalization expenses in rapid rehabilitation group were less than those in control group(P<0.05). The incidence of postoperative complications in rapid rehabilitation group(7.81%) was lower than that in control group(59.38%,P<0.05). Conclusion Rapid rehabilitation can quickly reconstruct the hip joint function of elderly femoral neck fracture patients with THA,improve the ability of daily life and quality of life,inhibit the release of pain factors,and promote rapid recovery,which is worthy of clinical application.
引文
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[15] Wainwright TW,Burgess LC.To what extent do current total hip and knee replacement patient information resources adhere to enhanced recovery after surgery principles[J].Physiotherapy,2018,104(3):327-337.
[16] 黄晓萍,喻耀华.髂筋膜间隙阻滞联合全身麻醉对髋关节置换术后疼痛及炎症应激介质分泌的影响[J].海南医学院学报,2018,24(5):604-607.
[17] 戴书静,刘佳.不同镇痛方式对全髋关节置换患者细胞因子及皮质醇水平的影响[J].解放军预防医学杂志,2015,33(4):421-422.
[18] DChoi SI,Hwang SW.Epolarizing effectors of bradykinin signaling in nociceptor excitation in pain perception[J].Biomol Ther (Seoul),2018,26(3):255-267.
[19] Liu Y,Liu W,Wang X,et al.Dexmedetomidine relieves acute inflammatory visceral pain in rats through the ERK Pathway,toll-like receptor signaling,and TRPV1 channel[J].J Mol Neurosci,2018,66(2):279-290.
[20] Dunne FJ,Getachew H,Cullenbrooke F,et al.Pain and pain syndromes[J].Br J Hosp Med (Lond),2018,79(8):449-453.
[21] Iannuccelli C,Guzzo MP,Atzeni F,et al.Pain modulation in patients with fibromyalgia undergoing acupuncture treatment is associated with fluctuations in serum neuropeptide Y levels[J].Clin Exp Rheumatol,2017,105(3):81-85.
[2] Tan NLT,Hunt JL,Gwini SM.Does implementation of an enhanced recovery after surgery program for hip replacement improve quality of recovery in an Australian private hospital:a quality improvement study[J].BMC Anesthesiol,2018,18(1):64.
[3] Berg U,BüLow E,Sundberg M,et al.No increase in readmissions or adverse events after implementation of fast-track program in total hip and knee replacement at 8 Swedish hospitals:an observational before-and-after study of 14,148 total joint replacements 2011-2015[J].Acta Orthop,2018,89(5):522-527.
[4] Dettoni F,Pellegrino P,La Russa MR,et al.Validation and cross cultural adaptation of the Italian version of the Harris Hip Score[J].Hip Int,2015,25(1):91-97.
[5] Brody L.日常生活能力量表(ADL)[J].中国微侵袭神经外科杂志,2006,11(11):516.
[6] 林岳卿,方积乾.世界卫生组织生存质量老年人量表简化版的研制[J].中国临床心理学杂志,2011,19(1):27-30,34.
[7] Costa ML,Achten J,Foguet P,et al.Comparison of hip function and quality of life of total hip arthroplasty and resurfacing arthroplasty in the treatment of young patients with arthritis of the hip joint at 5 years[J].BMJ Open,2018,8(3):e018849.
[8] Carli AV,Poitras S,Clohisy JC,et al.Variation in use of postoperative precautions and equipment following total hip arthroplasty:a survey of the AAHKS and CAS membership[J].J Arthroplasty,2018,33(10):3201-3205.
[9] Gargiulo P,Edmunds KJ,Gíslason MK,et al.Patient-specific mobility assessment to monitor recovery after total hip arthroplasty[J].Proc Inst Mech Eng H,2018,232(10):1048-1059.
[10] Cheatham SW,Enseki KR,Kolber MJ.Postoperative rehabilitation after hip arthroscopy:a search for the evidence[J].J Sport Rehabil,2015,24(4):413-418.
[11] Bartlett AS,Parton S,Lattuca J.Physical therapy self-management strategies for a patient with a total hip replacement and heart failure:a case report[J].Home Healthc Now,2018,36(5):304-311.
[12] Greimel F,Dittrich G,Schwarz T,et al.Course of pain after total hip arthroplasty within a standardized pain management concept:a prospective study examining influence,correlation,and outcome of postoperative pain on 103 consecutive patients[J].Arch Orthop Trauma Surg,2018,138(12):1639-1645.
[13] Wilches C,Sulbarán JD,Fernández JE,et al.Fast-track recovery technique applied to primary total hip and knee replacement surgery.Analysis of costs and complications[J].Rev Esp Cir Ortop Traumatol,2017,61(2):111-116.
[14] Mikkelsen LR,Mechlenburg I,S?balle K,et al.Effect of early supervised progressive resistance training compared to unsupervised home-based exercise after fast-track total hip replacement applied to patients with preoperative functional limitations:a single-blinded randomised controlled trial[J].Osteoarthritis Cartilage,2014,22(12):2051-2058.
[15] Wainwright TW,Burgess LC.To what extent do current total hip and knee replacement patient information resources adhere to enhanced recovery after surgery principles[J].Physiotherapy,2018,104(3):327-337.
[16] 黄晓萍,喻耀华.髂筋膜间隙阻滞联合全身麻醉对髋关节置换术后疼痛及炎症应激介质分泌的影响[J].海南医学院学报,2018,24(5):604-607.
[17] 戴书静,刘佳.不同镇痛方式对全髋关节置换患者细胞因子及皮质醇水平的影响[J].解放军预防医学杂志,2015,33(4):421-422.
[18] DChoi SI,Hwang SW.Epolarizing effectors of bradykinin signaling in nociceptor excitation in pain perception[J].Biomol Ther (Seoul),2018,26(3):255-267.
[19] Liu Y,Liu W,Wang X,et al.Dexmedetomidine relieves acute inflammatory visceral pain in rats through the ERK Pathway,toll-like receptor signaling,and TRPV1 channel[J].J Mol Neurosci,2018,66(2):279-290.
[20] Dunne FJ,Getachew H,Cullenbrooke F,et al.Pain and pain syndromes[J].Br J Hosp Med (Lond),2018,79(8):449-453.
[21] Iannuccelli C,Guzzo MP,Atzeni F,et al.Pain modulation in patients with fibromyalgia undergoing acupuncture treatment is associated with fluctuations in serum neuropeptide Y levels[J].Clin Exp Rheumatol,2017,105(3):81-85.