快速康复程序结合肌筋膜牵拉疗法促进全髋置换患者康复的临床研究

Clinical study on the effect of the therapy of rapid rehabilitation procedures combined with myofascial traction on promoting the recovery of patients with total hip arthroplasty

目的:观察基于快速康复理念的快速康复程序结合肌筋膜牵拉疗法对行全髋关节置换术患者的康复效果。方法:应用随机数字表将符合要求的97例行单侧全髋关节置换的患者随机分为3组:实验组32例,对照组34例,延期对照组31例。术后实验组和对照组患者即依照快速康复训练程序进行康复治疗,同时实验组患者在此基础上辨证加用肌筋膜牵拉疗法;延期对照组患者于术后1周开始采用快速康复训练程序进行锻炼。分别于术前、术后第1周、第2周和3个月时依照Harris评分标准评定患髋功能。同时观察各组并发症的发生情况。结果:治疗前后不同时间Harris评分比较,差异有统计学意义(F=7.771,P=0.000)。处理方法和测量时间不存在交互效应(F=0.170,P=0.960)。各处理组之间Harris评分比较,差异有统计学意义(F=19.830,P=0.000),进一步分析可知术前和术后3个月各组间比较,差异无统计学意义(F=2.060,P=0.175;F=13.886,P=0.068);术后1周和术后2周各组间比较,差异有统计学意义(F=19.467,P=0.027;F=17.131,P=0.043)。再对术后1周和术后2周3组间做两两比较:①术后1周。实验组评分高于对照组和延期对照组,对照组评分高于延期对照组(P=0.035,P=0.001,P=0.045)。②术后2周。实验组和对照组评分均高于延期对照组(P=0.015,P=0.042),实验组与对照组评分比较,差异无统计学意义(P=0.071)。对照组和延期对照组各有2例出现下肢深静脉血栓形成;实验组1例出现手术切口皮肤钉部分松动脱落。各组均未出现感染、脱位等并发症。结论:基于快速康复理念的快速康复程序结合肌筋膜牵拉疗法能缩短全髋关节置换患者的康复时间,使其早期离床活动,有效降低相关并发症的发生率,提高患者生活质量。

Objective：To observe the rehabilitation efficacy of the therapy of rapid rehabilitation procedures based on rapid rehabilitation concept combined with myofascial traction on patients with total hip arthroplasty.Methods：97 patients with unilateral total hip arthroplasty were randomly divided into 3 groups according to the random number table,32 cases in the experimental group,34 cases in the control group and 31 cases in the deferred control group.After the operation,patients in the experimental group and control group were all administrated with rapid rehabilitation training procedures,meanwhile the patients in the experimental group were administrated with additional myofascial traction therapy according to differentiation of symptoms and signs;while the others in the deferred control group were administrated with rapid rehabilitation training procedures one week after the operation.Functions of the affected hips were evaluated according to Harris scoring standards before the operation,the 1st week,2nd week and 3 months after the operation respectively,and the complications for each group were observed at the same time.Results：There was statistical difference in Harris scores among different time points（F=7.771,P=0.000）.There was no interaction effects between treatment process and measuring time points（F=0.170,P=0.960）.On the aspect of Harris scores,there was statistical difference among the 3 groups（F=19.830,P=0.000）.However,a further analysis showed that there was no statistical difference among the 3 groups 3 months after the operation and before the operation（F=2.060,P=0.175;F=13.886,P=0.068）,and there was statistical difference among the 3 groups 1 week and 2 weeks after the operation（F=19.467,P=0.027;F=17.131,P=0.043）.The results of pairwise comparison showed：①One week after the operation,scores of experimental group were higher than those of control group and deferred control group,and scores of control group were higher than those of deferred control group（P=0.035,P=0.001, P=0.045）;②Two weeks after the operation,scores of experimental group and control group were higher than those of deferred control group（P=0.015,P=0.042）,and there was no statistical difference in scores between experimental group and control group（P=0.071）.2 cases with deep vein thrombosis in lower limbs were found in control group and deferred control group respectively,1 case of partly looseness of nail in the operational incision was found in the experimental group.No infection,dislocation and other complications were found in each group.Conclusion：The therapy of rapid rehabilitation procedures based on rapid rehabilitation concept combined with myofascial traction can shorten the rehabilitation time for the patients with total hip arthroplasty,then make them carry out ambulation earlier,which decrease the incidence of complications effectively and improve their life quality.