术前日常活动量对全髋置换术的影响

Effect of preoperative daily activity on total hip arthroplasty for hip osteoarthritis

[目的]明确全髋关节置换术术前活动量与术后下肢功能的关系。[方法]以接受全髋关节置换的66例患者为研究对象,按照国际体力活动问卷评估术前1周活动量,44例患者活动量≥1000 kcal,列为活动组,另外22例患者活动量<1000kcal,列为少活动组。比较两组术前、术后资料。[结果]活动组在术前1周活动量[(3513.0±2840.0)kcal vs(429.0±312.0)kcal,P<0.001]、术前10 m步行时间[(7.7±2.4)s vs(10.4±8.3)s,P=0.049]、术后2个月VAS评分[(1.6±0.8)vs(2.2±1.1),P=0.014]、术后2个月外展肌力[(82.1±29.5)%vs(67.1±25.9)%,P=0.047]、术前Harris评分[(54.7±10.2)vs(47.8±10.3),P=0.012]和术后2个月Harris评分[(75.0±7.3)vs(65.7±8.1),P<0.001]均显著优于少活动组。两组在年龄、性别、病程、BMI、术后2个月10 m步行时间、术前疼痛VAS评分、术前外展肌力、术前和术后2个月髋伸屈ROM和髋内-外旋ROM的差异均无统计学意义(P>0.05)。相关分析方面,术前1周活动量与术前的10 m步行时间呈显著负相关(r=-0.223,P=0.032),但与术后10 m步行时间无显著相关性(P>0.05);与术前的VAS评分无显著相关性(P>0.05),但与术后VAS评分呈显著负相关(r=-0.291,P=0.021);与术前的髋关节外展肌力无显著相关性(P>0.05),但与术后髋关节外展肌力呈显著正相关(r=0.337,P=0.012);与术前术后的髋伸屈ROM、髋内-外旋ROM均无相关性(P>0.05);与术前(r=0.293,P=0.019)、术后2个月(r=0.389,P=0.003)的Harris评分均呈显著正相关。[结论]THA患者术前活动量和Harris髋关节功能、VAS评分以及外展肌力存在一定关系。术前活动量大有利于术后恢复。

[Objective]To investigate the relationship between preoperative activity and postoperative lower extremity function after to-tal hip arthroplasty.[Methods]A total of 66 patients who underwent total hip replacement were selected as the study objects.The activitylevel of the week before surgery was assessed according to the international physical activity questionnaire.Forty-four patients with activitylevel≥1000 kcal were classified as the activity group,and the other 22 patients with activity level<1000 kcal were classified as the low ac-tivity group.The preoperative and postoperative data of the two groups were compared.[Results]The activity group demonstrated significant-ly higher levels of physical activity one week prior to surgery[(3513.0±2840.0)kcal vs(429.0±312.0)kcal,P<0.001],shorter time to walk10 meters preoperatively[(7.7±2.4)s vs(10.4±8.3)s,P=0.049],lower VAS scores at 2 months postoperatively[(1.6±0.8)vs(2.2±1.1),P=0.014],greater hip abduction strength at 2 months postoperatively[(82.1±29.5)%vs(67.1±25.9)%,P=0.047],higher Harris scores preopera-tively[(54.7±10.2)vs(47.8±10.3),P=0.012],and higher Harris scores at 2 months postoperatively[(75.0±7.3)vs(65.7±8.1),P<0.001]com-pared to the less active group.There were no significant differences between the two groups in terms of age,gender,disease duration,BMI,10-meter walk time at 2 months postoperatively,preoperative VAS pain score,preoperative abduction strength,preoperative and postopera-tive 2-months hip flexion-extension range of motion(ROM),and hip internal-external rotation ROM(P>0.05).In terms of correlation analy-sis,the activity level 1 week before surgery was significantly negatively correlated with the 10 m walking time before surgery(r=-0.223,P=0.032),but had no correlation with the 10 m walking time after surgery(P>0.05);not correlated with the preoperative VAS scores(P>0.05),but there was a significant negative correlation with postoperative VAS score(r=-0.291,P=0.021).The activity level 1 week before surgerywas not correlation with preoperative hip abduction muscle strength(P>0.05),but was significantly positively correlated with postoperativehip abductor muscle strength(r=0.337,P=0.012);nor correlated with the preoperative and postoperative hip extension ROM and the inter-nal-external rotation ROM(P>0.05),but significantly positively correlated with Harris scores before surgery(r=0.293,P=0.019)and 2months after surgery(r=0.389,P=0.003).[Conclusion]Preoperative activity of THA patients is correlated with Harris hip function,VASscore and abductor muscle strength.High preoperative activity is conducive to postoperative recovery.