预康复训练对全髋关节置换术后关节功能康复效果影响的系统评价

Effect of prerehabilitation training on joint function after total hip replacement:a systematic review

[目的]系统评价预康复训练对全髋关节置换术病人术后关节功能恢复的影响。[方法]制定系统检索策略,检索the Cochrane Library、CINAHL、EMbase、OVID、PubMed、Web of Science、PEDro、中国生物医学文献数据库CBM、中国知网、万方和维普数据库,筛选文献并提取资料,对符合标准的随机对照试验使用RevMan 5.3进行Meta分析。[结果]共纳入16篇文献,共994例研究对象。Meta分析结果显示,预康复训练可以改善起立-行走计时测试(Timed Up and Go test,TUG)评分[MD=4.20,95%CI(2.72,5.67),P<0.00001],改善髋关节活动度(range of motion,ROM)外展外旋功能,减轻病人术后疼痛[MD=0.42,95%CI(0.17,0.67),P=0.001],并且减少并发症的发生[RR=-0.24,95%CI(-0.33,-0.14),P<0.01];试验组髋关节Harris评分(Hip Harris Score,HHS)优于对照组[出院时MD=-0.57,95%CI(-0.91,-0.24),P=0.0008;术后3个月MD=-10.58,95%CI(-11.94,-9.22),P<0.00001];6项研究报告坚持预康复训练的依从性均较好。[结论]现有证据表明,预康复训练在一定程度上可以改善术后髋关节功能;建议有更多大样本的研究进行验证,进一步对预康复训练的方案包括锻炼内容、强度、频率、持续时间等展开研究。

Objective:To systematically evaluate the effect of prerehabilitation training on joint function after total hip arthroplasty.Methods:The system retrieval strategy formulated,and the Cochrane Library,CINAHL,EMBASE,Ovid,PubMed,Pedro,CBM,CNKI,Wanfang and VIP databases were searched to screen the literatures and extract the data.Revman 5.3 was used for Meta-analysis of randomized controlled trials that met the criteria.Results:A total of 16 papers were inc luded,involving 994 patients.The Meta-analysis results showed that prerehabilitation training could improve TUG score[MD=4.20,95%CI(2.72,5.67),P<0.00001],ROM abduction and external rotation function,relieve postoperative pain[MD=0.42,95%CI(0.17,0.67),P=0.001],and reduce the occurrence of complications[RR=-0.24,95%CI(-0.33,-0.14),P<0.01].The hip Harris score(HHS)of the experimental group was better than that of the control group[on discharge MD=-0.57,95%CI(-0.91,-0.24),P=0.0008;3 months after operation MD=-10.58,95%CI(-11.94-9.22),P<0.00001].Six studies reported that the compliance of prerehabilitation training was betted.Conclusion:Current evidence showed that to some extent,prerehabilitation training could improve hip joint function after operation,but it is suggested that more large sample studies to should be carried out to verify the prerehabilitation training program,including exercise content,intensity,frequency,duration,etc.