老年髋关节置换术后定向肌群训练的意义△

Significance of muscle group orientated training after total hip arthroplasty in elderly

摘要:

[目的]探讨老年髋关节置换术患者进行腰腹肌群和髋周肌群引导训练对术后恐动症、髋关节功能和生活质量的影响。[方法] 选取 2022 年 2 月—2022 年 12 月行髋关节置换术的老年股骨颈骨折患者 77 例，根据医患沟通结果将患者分两组，38 例给予腰腹肌群和髋周肌群引导训练 （训练组），39 例给予常规康复训练 （常规组）。比较两组恐动症 TSK-17 评分、 髋关节功能 Harris 评分、疼痛 NRS 评分和生活质量 SF-12 评分的差异。[结果]术前两组间上述各项评分均无显著性差异（P＞ 0.05）。术后第 3 d，训练组的 TSK-17 评分显著低于常规组 [(32.2±7.0) vs (37.2±6.5), P=0.002]，前者的 SF-12 评分显著高于后者 [(63.1±9.2) vs (56.6±9.1), P=0.003]，但两组间的 Harris 和 NRS 评分差异无统计学意义 （P＞0.05）。术后 1 个月训练组的 TSK-17 [(25.3±4.3) vs (30.7±5.5), P＜0.001]、NRS 评分 [(1.1±0.6) vs (2.4±1.0), P＜0.001] 均显著低于常规组，而 Harris 评分 [(75.3±4.5) vs (70.6± 6.8), P＜0.001] 和 SF-12 评分 [(70.9±7.4) vs (65.8±9.0), P=0.008] 均显著高于常规组。末次随访时，训练组的 TSK-17 评分 [(4.8±4.6) vs (7.3±5.7), P=0.033] 和 NRS 评分 [(0.6±0.5) vs (1.1±0.8), P=0.005] 均显著低于常规组，而训练组的 Harris [(81.8±5.4) vs (79.6±4.6), P=0.045] 和 SF-12 评分 [(77.8±8.3) vs (73.9±7.2), P=0.030] 均显著高于常规组[结论] 老年 THA 术后患者腰腹肌群和髋周肌群定向引导训练能够有效降低术后恐动症的发生率，增强髋关节功能活动，提高生活质量水平。

Abstract:

[Objective] To explore the clinical outcomes of lumbar, abdominal and hip muscle group orientated training on postoperative kinesiophobia, hip function, and quality of life in the elderly who underwent total hip arthroplasty (THA). [Methods] A total of 77 elderly patients who were undergoing THA for femoral neck fractures from February 2022 to December 2022 were included in this study, and divided into two groups according to the doctor-patient communication. Of them, 38 patients received the lumbar, abdominal and hip muscle group orientated training (the training group), while 39 patients received routine rehabilitation training (the conventional group). The differences in TSK-17 score, Harris score for hip joint function, NRS score for pain, and SF-12 score for quality of life were searched between the two groups. [Results] There was no significant difference in the abovementioned scores between the two groups before surgery (P＞0.05). The training group proved significantly less TSK-17 score [(32.2±7.0) vs (37.2±6.5), P=0.002], whereas significantly greater SF-12 score [(63.1±9.2) vs (56.6± 9.1), P=0.003] than the conventional group, despite of the fact that there was no statistically significant difference in Harris and NRS scores between the two groups 3 days postoperatively (P＞0.05). In addition, the training group was marked significantly lower TSK-17 score [(25.3± 4.3) vs (30.7±5.5), P＜0.001] and NRS score [(1.1±0.6) vs (2.4±1.0), P＜0.001], while significantly higher Harris score [(75.3±4.5) vs (70.6± 6.8), P＜0.001] and SF-12 score [(70.9±7.4) vs (65.8 ± 9.0), P=0.008] than the conventional group a week postoperatively. Furthermore, the training group also proved significantly lower TSK-17 score [(4.8±4.6) vs (7.3±5.7), P=0.033] and NRS score [(0.6±0.5) vs (1.1 ± 0.8), P= 0.005], while significantly higher Harris score [(81.8±5.4) vs (79.6±4.6), P=0.045] and SF-12 score [(77.8±8.3) vs (73.9±7.2), P=0.030] than the conventional group at the latest follow-up. [Conclusion] The lumbar, abdominal and hip muscles orientated training after THA in elderly does effectively reduce the incidence of postoperative kinesiophobia, enhance hip functional activity, and improve quality of life.