动静互补平衡论功能锻炼结合阶梯性康复训练利于全髋关节置换者术后髋关节功能恢复

Dynamic and Static Complementary Balance Theory-Based Functional Exercise Combined With Stepwise Rehabilitation Training Improves Postoperative Hip Function Recovery in Patients Undergoing Total Hip Replacement

目的 分析动静互补平衡论的功能锻炼结合阶梯性康复训练在全髋关节置换(total hip replacement, THR患者术后髋关节功能恢复的应用价值。方法 回顾性收集2022年6月–2023年6月收治的118例THR患者临床资料,其中57例围术期给予阶梯性康复训练(对照组),61例围术期行动静互补平衡论功能锻炼结合阶梯性康复训练(联合组)。记录两组术后恢复情况及术后并发症发生情况,在围术期评估两组患者疼痛[视觉模拟评分法(visual analogue scale, VAS)]及自我效能感[康复自我效能感量表(Self-Efficacy for Rehabilitation Outcome Scale, SER)],比较两组术后2周、4周、8周髋关节功能。结果 主要结局指标:联合组术后住院时间为(7.63±1.36) d,低于对照组的(8.22±1.48) d,差异有统计学意义(t=2.257,P=0.026)。次要结局指标:两组术后并发症发生率比较(4.92%vs. 14.04%),差异无统计学意义(P>0.05)。两组围术期VAS评分经重复测量方差检验显示具有交互效应(P<0.05),两组术后VAS评分均较术前降低(P<0.05),且随术后时间的延长逐渐降低(P<0.05),联合组术后7 d及14 d VAS评分低于对照组(P<0.05)。术后14 d,两组应对及任务维度SER评分及其总分均较术后3 d升高(P<0.05),联合组高于对照组(P<0.05)。两组术后畸形、疼痛、功能、关节活动度维度Harris髋关节功能评分及其总分经重复测量方差检验显示具有交互效应(P<0.05),两组Harris髋关节功能各维度评分及其总分均随术后时间的延长逐渐升高(P<0.05),联合组术后4周及8周评分均高于对照组(P<0.05)。结论 动静互补平衡论的功能锻炼结合阶梯性康复训练在提高THR患者自我效能感、缓解术后疼痛、减少住院时间和改善患者髋关节功能方面,比单纯进行阶梯性康复训练更具优势。

Objective To analyze the application value of dynamic and static complementary balance theory-based functional exercise combined with stepwise rehabilitation training in postoperative hip function recovery in patients undergoing total hip replacement(THR).Methods The clinical data of 118 inpatients undergoing THR between June 2022 and June 2023 were retrospectively collected.Among the patients,57 were given perioperative stepwise rehabilitation training(the control group),and 61 were given a combination of functional exercise based on static and dynamic complementary balance theory and stepwise rehabilitation training during the perioperative period(the combination group).The postoperative recovery status and the incidence of postoperative complications in the two groups were recorded.During postoperative recovery,the patients were assessed for pain with the visual analogue scale(VAS)and for self-efficacy with the Self-Efficacy for Rehabilitation Outcome Scale(SER).Hip function was measured and compared between the two groups at 2 weeks,4 weeks and 8 weeks after surgery.Results With regard to the primary outcome indicator,the postoperative length-of-stay was(7.63±1.36)d in the combination group,which was shorter than the(8.22±1.48)d in the control group,and the difference was statistically significant(t=2.257,P=0.026).As for the secondary outcome indicators,no statistically significant difference was observed in the incidence of postoperative complications between the two groups(4.92%vs.14.04%)(P>0.05).The perioperative VAS scores in the two groups showed an interaction effect according to the repeated measurement variance test(P<0.05).The postoperative VAS scores in both groups declined significantly compared to the preoperative scores(P<0.05),and the VAS score decreased gradually over time after surgery(P<0.05).The VAS scores in the combination group at 7 and 14 days after surgery were lower than those in the control group(P<0.05).At 14 days after surgery,the scores for the coping and the task dimensions and the total score of SER increased in both groups compared with those at 3 days after surgery(P<0.05),with the combination group showing higher scores than the control group did(P<0.05).After surgery,the scores for the dimensions of deformity,pain,function,and joint mobility and the total score of the Harris Hip Scale revealed interaction effects in the two groups according to the repeated measurement variance test(P<0.05),with these scores increasing gradually over time after surgery(P<0.05),and the scores in the combination group were higher at 4 and 8 weeks after surgery compared to those in the control group(P<0.05).Conclusion The combination of functional exercise based on dynamic and static complementary balance theory and stepwise rehabilitation training shows an advantage over stepwise rehabilitation training alone in enhancing the self-efficacy of THR patients,relieving the postoperative pain,shortening the length-of-stay,and improving the hip function in patients.