术前日常活动量对全髋置换术的影响△

Effect of preoperative daily activity on total hip arthroplasty for hip osteoarthritis

摘要:

[目的] 明确全髋关节置换术术前活动量与术后下肢功能的关系。[方法] 以接受全髋关节置换的66 例患者为研究对象，按照国际体力活动问卷评估术前1 周活动量，44 例患者活动量≥1 000 kcal，列为活动组，另外22 例患者活动量＜1 000kcal，列为少活动组。比较两组术前、术后资料。[结果] 活动组在术前1 周活动量[(3 513.0±2 840.0) kcal vs (429.0±312.0) kcal,P＜0.001]、术前10 m 步行时间[(7.7±2.4) s vs (10.4±8.3) s, P=0.049]、术后2 个月VAS 评分[(1.6±0.8) vs (2.2±1.1), P=0.014]、术后2个月外展肌力[(82.1±29.5)% vs (67.1±25.9)%, P=0.047]、术前Harris 评分[(54.7±10.2) vs (47.8±10.3), P=0.012] 和术后2 个月Harris评分[(75.0±7.3) vs (65.7±8.1), P＜0.001] 均显著优于少活动组。两组在年龄、性别、病程、BMI、术后2 个月10 m 步行时间、术前疼痛VAS 评分、术前外展肌力、术前和术后2 个月髋伸屈ROM 和髋内-外旋ROM 的差异均无统计学意义（P＞0.05）。相关分析方面，术前1 周活动量与术前的10 m 步行时间呈显著负相关（r=-0.223, P=0.032），但与术后10 m 步行时间无显著相关性（P＞0.05）；与术前的VAS 评分无显著相关性（P＞0.05），但与术后VAS 评分呈显著负相关（r=-0.291, P=0.021）；与术前的髋关节外展肌力无显著相关性（P＞0.05），但与术后髋关节外展肌力呈显著正相关（r=0.337, P=0.012）；与术前术后的髋伸屈ROM、髋内-外旋ROM 均无相关性（P＞0.05）；与术前（r=0.293, P=0.019）、术后2 个月（r=0.389, P=0.003） 的Harris 评分均呈显著正相关。[结论] THA 患者术前活动量和Harris 髋关节功能、VAS 评分以及外展肌力存在一定关系。术前活动量大有利于术后恢复。

Abstract:

[Objective] To investigate the relationship between preoperative activity and postoperative lower extremity function after to-tal hip arthroplasty. [Methods] A total of 66 patients who underwent total hip replacement were selected as the study objects. The activitylevel of the week before surgery was assessed according to the international physical activity questionnaire. Forty-four patients with activitylevel ≥1 000 kcal were classified as the activity group, and the other 22 patients with activity level ＜1 000 kcal were classified as the low ac-tivity group. The preoperative and postoperative data of the two groups were compared. [Results] The activity group demonstrated significant-ly higher levels of physical activity one week prior to surgery [(3 513.0±2 840.0) kcal vs (429.0±312.0) kcal, P＜0.001], shorter time to walk10 meters preoperatively [(7.7±2.4) s vs (10.4±8.3) s, P=0.049], lower VAS scores at 2 months postoperatively [(1.6±0.8) vs (2.2±1.1), P=0.014], greater hip abduction strength at 2 months postoperatively [(82.1±29.5)% vs (67.1±25.9)%, P=0.047], higher Harris scores preopera-tively [(54.7±10.2) vs (47.8±10.3), P=0.012], and higher Harris scores at 2 months postoperatively [(75.0±7.3) vs (65.7±8.1), P＜0.001] com-pared to the less active group. There were no significant differences between the two groups in terms of age, gender, disease duration, BMI,10-meter walk time at 2 months postoperatively, preoperative VAS pain score, preoperative abduction strength, preoperative and postopera-tive 2-months hip flexion-extension range of motion (ROM), and hip internal-external rotation ROM (P＞0.05). In terms of correlation analy-sis, the activity level 1 week before surgery was significantly negatively correlated with the 10 m walking time before surgery (r=-0.223, P=0.032), but had no correlation with the 10 m walking time after surgery (P＞0.05); not correlated with the preoperative VAS scores (P＞0.05),but there was a significant negative correlation with postoperative VAS score (r=-0.291, P=0.021). The activity level 1 week before surgerywas not correlation with preoperative hip abduction muscle strength (P＞0.05), but was significantly positively correlated with postoperativehip abductor muscle strength (r=0.337, P=0.012); nor correlated with the preoperative and postoperative hip extension ROM and the inter-nal-external rotation ROM (P＞0.05), but significantly positively correlated with Harris scores before surgery (r=0.293, P=0.019) and 2months after surgery (r= 0.389, P=0.003). [Conclusion] Preoperative activity of THA patients is correlated with Harris hip function, VASscore and abductor muscle strength. High preoperative activity is conducive to postoperative recovery.