全髋置换术后采用普拉提康复与传统康复的疗效对比观察

A comparative study of the effects of Pilates and conventional rehabilitation treatment after total hip arthro-plasty

目的观察全髋置换术（THA）后普拉提训练与传统康复训练的疗效差异。方法选取经微创小切口全髋置换手术患者58例，采用随机数字表法将其分为普拉提训练组（观察组）及传统康复训练组（对照组），观察组术后给予普拉提康复训练持续6个月，对照组术后在医院内给予常规康复训练1～2个月，出院后继续自行锻炼。于手术后1个月、3个月及6个月时对2组患者髋关节功能进行Harris评分，同时采用改良Barthel指数（MBI）评定2组患者术后日常生活活动（ADL）能力，记录比较2组患者术后首次下床活动时间、住院天数及术后并发症情况。结果术后1个月时发现观察组患者Harris评分[（59．78±6．22）分]显著优于对照组[（51．26±3．42）分]（P〈0．05）；术后3个月及6个月时发现观察组患者Harris评分[分别为（82．12±3．32）分、（91．42±5．91）分]及对照组Harris评分[分别为（79．31±6．93）分、（90．67±6．13）分]均显著优于术后1个月时评分（P〈0．05）。术后1个月时观察组患者MBI评分[（52．56±16．67）分]明显优于对照组MBI评分[（45．63±15．24）分]（P〈0．05）；术后3个月及6个月时发现观察组MBI评分[分别为（58．39±13．32）分、（81．17±13．87）分]及对照组MBI评分[分别为（56．46±16．93）分、（80．67±15．13）分]均显著优于术后1个月时评分（P〈0．05）。术后3个月、6个月时2组患者Harris评分及MBI评分组间差异均无统计学意义（P〉0．05）。另外观察组患者术后首次下床活动时间[（2．0±1．3）d]、住院天数[（6．3±1．4）d]及术后并发症发生情况均显著优于对照组（P〈0．05）。结论小切口微创THA后采用普拉提康复训练能进一步促进患者早期功能恢复，较传统康复训练起效更快、疗效更显著，值得临床推广、应用。

Objective To compare the therapeutic effect of Pilates and conventional training after total hip arthroplasty （THA）. Methods Fifty-eight patients who had undergone minimally invasive total hip replacement surgery were divided into an observation group （ n = 29） and a control group （ n = 29） using a random number table. The observation group was given Pilatcs rehabilitation training, including a series of exercises especially designed for this condition, for 6 months after the operation. The control group was provided with conventional postoperative reha- bilitation training including passive range of motion exercise, balance training, etc. , lasting for 1 to 2 months in hos- pital, followed by self-training after discharge. At 1 month, 3 months and 6 months after the operation hip joint func- tion was evaluated in both groups using the Harris hip score and the modified Barthel index （ MBI）. The time for first out-of-bed activity after the operation, length of hospital stay and postoperative complications of the two groups were also recorded. Results At 1 month after the operation, the average Harris hip score and MBI score of the observa- tion group were significantly better than those of the control group [ （59.78± 6.22） vs （51.26 ± 3.42） and （52.56 ±16.67 ） vs （45.63 ± 15.24） , respectively ]. Two and 4 months later, in the observation group the average Harris hip score had improved significantly to （82.12 ± 3.32） and further to （91.42 ±5.91 ） , while the MBI score increased significantly to （58.39 ± 13.32） and （81.17± 13.87）. The same tendency was observed in the control group and at those two time points no significant difference was observed between the observation group and the con- trol group. The patients in the observation group had their first out-of-bed ambulation significantly earlier, a signifi- cantly shorter average hospital stay and significantly fewer postoperative complications. Conclusion Pilates training after minimally invasive THA can promote earlier and quicker functional recovery than conventional rehabilitation training.