髋关节置换后生活活动能力与效果评价:社区回访

Daily living activities and effect evaluation following total hip replacement: Community return visit

背景:髋关节置换是一种重建髋关节功能且疗效十分显著的骨科手术,但如果置换后卧床时间过长,未及早地进行康复治疗,患者可出现不同程度的肌力减退及关节挛缩,影响关节功能的恢复及手术的疗效。目的:探讨髋关节置换后回访社区继续康复治疗的生活活动能力与效果评价。方法:选择髋关节置换患者28例,年龄78.1(68～81)岁;男16例,女12例。将患者随机分为治疗组与对照组。治疗组患者于髋关节置换后15d出院转入本社区卫生服务中心进行继续跟踪康复锻炼,根据假体的稳定性、患者的年龄、体质、置换后时间的长短等制定康复训练计划,训练1个月。对照组只定期随访,未进行相关的康复训练。两组患者在社区卫生服务中心进行入院第1天、1个月、6个月跟踪随访,通过Harris评定和Barthel评定肌力变化。结果与结论:治疗组患者均按时回访,对照组患者中1例因摔倒骨折入中心医院,1例心脏病发作死亡,2例因外出未回无法取得联系,脱落复诊4例。两组患者置换后到社区卫生中心第1天、1个月、6个月的日常生活活动能力指数、Harris评定与Barthel指数评分均明显提高,且1,6个月治疗组上述指标高于对照组(P<0.01)。结果说明髋关节置换后患者通过转入社区卫生服务中心继续进行功能训练有助于日常生活活动能力与功能疗效的提高。

BACKGROUND： Hip replacement is a reconstruction of the hip joint function with a significant efficacy in orthopedic surgery. When lying in bed for a long period of time after replacement and failing to perform rehabilitation, the patients might have different degrees of motor weakness and joint contractures, affecting the restoration of joint function and surgical efficacy. OBJECTIVE： To explore a return visit after hip replacement rehabilitation to continue the life activity and efficacy evaluation. METHODS： A total of 28 patients, aged 78.2 （68-81） years, 16 males and 12 females, were selected, who were admitted for the hip joint replacement. The patients were randomly divided into treatment and control groups. Patients from the reatment group were discharged into the community health service centers at 15 days after hip replacement for rehabilitation exercise for 1 month, according to the stability of prosthesis, patient age, and physical condition, such as replacement time. The control group was only followed up without the associated rehabilitation. Two groups were followed up at 1 day, 1 and 6 months in the community health service centers subjected to Harris and Barthel assessment by muscle strength. RESULTS AND CONCLUSION： Treatment group was followed up, but in the control group 1 case was admitted to the central hospital due to falling-caused fracture, 1 case died of heart attack, 2 cases did not go back or get in touch, and 4 were off return visit. The activities of daily living index, Harris Assessment and Barthel Index score significantly improved in two groups of patients at 1 day, 1 and 6 months in community health center, and 1, 6-month above parameters in the treatment group were significantly greater than the control group （P 0.01）. Results suggest that functional training in the community health service center improves of daily living activity and function efficacy of patients after total hip replacement.