任务导向联合早期负重训练对全髋关节置换术后患者康复效果的影响

Impact of task-oriented approach combined with early weight training on rehabilitation efficacy in patients after total hip arthroplasty

目的观察任务导向联合早期负重训练对老年患者全髋关节置换术(THA)后康复效果的影响。方法将84例老年THA术后患者随机分为任务导向组和常规康复组,每组42例。任务导向组患者采用任务导向联合早期负重训练,术后第7天进行一般的康复训练,术后3周开始进行负重训练;常规康复组患者术后6周进行常规康复练习和负重训练,两组患者均训练3个月。分别于术前、术后3个月、术后1年,采用Harris髋关节评分量表评价患者髋关节功能,采用简明健康状况调查问卷(SF-36)评价患者生存质量。观察两组患者术后1年内并发症发生情况。结果两组患者的疼痛、跛行、病残、日常活动、髋关节活动、肌力的Harris评分均有随时间延长而升高的趋势,术后3个月、1年,各Harris指标评分均高于术前,且任务导向组高于常规康复组(均P<0.05)。两组患者躯体功能、躯体角色、肢体疼痛、总的健康状况、活力、社会功能、情绪角色、心理卫生的SF-36评分均有随时间变化的趋势,术后3个月、1年,各生存质量指标SF-36评分均高于术前,且任务导向组高于常规康复组(均P<0.05)。术后1年,任务导向组并发症发生率低于常规康复组(P<0.05)。结论任务导向联合早期负重训练能够提高老年THA术后患者髋关节功能,改善患者生存质量,降低并发症发生率。

Objective To observe the impact of task-oriented approach combined with early weight training on the postoperative rehabilitation efficacy of elderly patients undergoing total hip arthroplasty(THA).Methods Eighty-four elderly patients after THA were randomly divided into task-oriented group and routine rehabilitation group,with 42 cases in each group.The patients of the task-oriented group underwent task-oriented approach combined with early weight training which consisted of general rehabilitation training at the 7 th after operation and weight-training from 3 weeks after operation;the patients of the routine rehabilitation group received routine rehabilitation and weight training at 6 weeks after operation,and three-month training was performed in both groups.Before operation,at 3 months and 1 year after operation,Harris hip score was employed to evaluate the hip joint function of patients,the36-Item Short Form Healthy Survey(SF-36)was performed to assess the life quality of patients.The occurrence of complications was observed in both groups.Results For the patients of both groups,the Harris scores of pain,claudication,disability,daily activities,hip joint activity and muscle strength exhibited a tendency to elevation over time,and the scores of the indicators mentioned above were all higher at 3 months and 1 year after operation than those before operation(all P<0.05);the Harris score of each indicator in the task-oriented group was higher than those in the routine rehabilitation group(all P<0.05).For the patients of both groups,the SF-36 scores tended to change over time in respect of physical function,role-physical,body pain,overall health status,vitality,social function,role-emotional and mental health,and the SF-36 score of each life quality indicator was higher at 3 months and 1 year after operation than those before operation(all P<0.05);the score of each indicator was higher in the task-oriented group than that in the routine rehabilitation group(all P<0.05).One year after operation,the incidence rate of complications was lower in the task-oriented group than that in the routine rehabilitation group(P<0.05).Conclusion Task-oriented approach combined with early weight training can improve the hip function and quality of life,and decrease the incidence of complications in the elderly patients after THA.