全髋置换后康复干预时间与效果的比较

Comparison of different intervention time of systematic rehabilitation following total hip replacement

背景:观察全髋置换后康复干预开始时间对临床效果的影响。方法:回顾性分析2000-07/2008-03湘南学院附属医院骨科收治的行全髋关节置换后康复治疗的患者165例,根据置换后行康复治疗时间的不同分为3组,早期康复组(n=56):男27例,女29例;年龄44～79岁,置换前患髋Harris评分为(47.4±1.3)分,全髋置换后3d行康复治疗。中期康复组(n=63):男37例,女26例;年龄48～80岁,置换前Harris评分(45.6±2.1)分,全髋置换4～21d后行康复治疗。延迟康复组(n=46):男24例,女22例;年龄47～81岁,置换前Harris评分(46.3±1.5)分,全髋置换21d后行康复治疗。3组按统一制定的康复训练计划实施功能锻练。于置换前,置换后1,2,3个月行Harris评分比较。结果:行康复治疗的患者165例均进入结果分析。置换前3组髋关节Harris评分差异无显著性意义(P>0.05);康复治疗后,置换后1个月Harris评分早期康复组平均(89.1±6.3)分,中期康复组平均(60.1±3.7)分,延迟康复组平均(54.6±3.5)分,早期康复组得分高于中期康复组及延迟康复组(P<0.05)。置换后2个月Harris评分早期康复组平均(90.1±4.3)分,中期康复组平均(85.7±5.3)分,延迟康复组平均(69.8±3.8)分,早期康复组、中期康复组与延迟康复组之间相比,差异有显著性意义(P<0.05)。置换后3个月Harris评分早期康复组平均(94.8±2.3)分,中期康复组平均(92.2±3.2)分,延迟康复组平均(90.5±3.1)分,3组之间相比,差异无显著性意义(P>0.05)。结论:早期系统康复治疗有利于全髋置换后髋关节功能的恢复。

OBJECTIVE： To explore the effect of time of prospective intervention for systematic rehabilitation in the patients undergoing total hip replacement. METHODS： 165 patients with total hip replacement were selected from Department of Orthopaedics, Affiliated Hospital of Xiangnan University between July 2000 and May 2008, and randomly divided into 3 groups： early rehabilitation group （n=56）, including 27 male and 29 female, aged 44-79 years, with preoperative Harris scores of （47.4±1.3）, who underwent rehabilitation therapy 3 days after total hip replacement; middle-stage rehabilitation group （n=63）, including 37 male and 26 females, aged 48-80 years, with preoperative Harris scores of （45.6±2.1）, who underwent rehabilitation protocol from 4 d to 21 d postoperatively; late rehabilitation group （n=46）, including 24 male and 22 females, aged 47-81 years, with preoperative Harris scores of （46.3±1.5）, who underwent rehabilitation protocol since 21d postoperatively. The three groups did the functional exercise according to unified plans. Harris score system was used to evaluate the hip joint functions of the patients before operation and 1, 2 and 3 months after operation respectively. RESULTS： 165 patients were included in the final analysis. The preoperative average Harris score showed no significant difference among the three groups （P 〉 0.05）. After systematic rehabilitation protocol, the average Harris score was 89.1±6.3 in early group, 60.1±3.7 in middle-stage group and 54.6±3.5 in late group 1 month after operation. The early group was significantly greater than the other groups （P 〈 0.05）. The average Harris score was 90.1±4.3 in early group, 85.7±5.3 in middle-stage group and 69.8±3.8 in late group 2 months after operation. The early and middle-stage groups showed significant differences compared with late group （P〈 0.05）. The average Harris score was 94.8±2.3 in early group, 92.2±3.2 in middle-stage group and 90.5±3.1 in late group 3 months after operation. No significant difference was found among the three groups （P 〉 0.05）. CONCLUSION： Early intervention of systematic rehabilitation benefits functional recovery of the patients undergoing total hip replacement.