全髋关节置换术后1年关节功能的定量分析

Quantitative analysis of joint function in one year after total hip arthroplasty

背景:Harris评分是全髋关节置换术(THA)后最常用的评价指标,但该指标为多项评分的综合,无法对THA术后关节功能进行定量评价。目的目的:定量评价THA术前及术后1年内各时点的关节功能恢复状况,分析其与Harris评分变化的相关性,探讨术后康复训练的相应对策。方法方法:选择2012年4月至2013年9月行THA的27例患者,男18例,女9例;年龄37~62岁,平均(49.3±7.6)岁。术前及术后3个月、6个月、9个月和1年分别采用爬楼梯测试、5次坐立试验、计时'起立-行走'测试、6 min步行测试、单腿站立试验5种定量评价方法测量髋关节功能,分析上述定量评价指标与Harris评分的变化趋势,并将术后1年的定量评价指标与正常人群进行比较。结果结果:术后1年各时点的单腿站立时间明显延长,与术前比较均有统计学差异(P<0.05)。其余4种定量评价指标术后早期(术后3个月)均呈下降趋势,除5次坐立试验外,爬楼梯测试、计时'起立-行走'测试及6 min步行测试结果与术前比较均有统计学差异(P<0.05);至术后6个月,各指标逐渐上升至接近或超过术前水平,但与术前比较均无统计学差异(P>0.05);至术后1年仍未达正常人水平(P>0.05)。术后Harris评分较术前有明显升高(P<0.05),与各定量评价指标均无相关性。结论结论:THA术后1年内各时点关节功能恢复状况的定量评价指标与Harris评分不一致,且术后早期(术后3个月)关节功能的定量评价指标处于最低点,应尽早开展有针对性的康复训练,以促进关节功能恢复。

Background: Harris score is the most common assessment index for total hip arthroplasty(THA). But it is a comprehensive method and unable to obtain quantitative evaluation of joint function.Objective: To analyze joint function quantitatively in one year after THA and to evaluate its correlation with the Harris score.Methods: Twenty- seven patients undergoing THA between April 2012 and September 2013 were recruited in this study.Quantitative assessment including stair climb, five times sit-to-stand, timed-up-and-go, 6-minute walk test, and single-limb stance time were used to evaluate hip joint function preoperatively, 3 months, 6 months, 9 months and 12 months postoperatively. Their correlation with the Harris score was analyzed. One-year postoperative assessment parameters were compared with those in general population.Results: Single-limb stance time at each time point of one year after THA was significantly longer than preoperative one(P<0.05). The time of stair climb, timed-up-and-go and 6-minute walk test 3 months postoperatively was significantly longer than preoperative one(P<0.05). The time of five times sit-to-stand slightly increased 3 months postoperatively, but it was not significantly different from preoperative one(P>0.05). All the five indicators were improved at 6 months postoperatively, but they were not significantly different from preoperative one(P>0.05). No statistical difference was found in all the assessment results between the patients and healthy adults(P>0.05). Postoperative Harris score at each time point was significantly more than preoperative one(P<0.05), and there was no correlation between Harris score and quantitative indicators.Conclusions: There is no correlation between quantitative analysis and Harris score one year after THA. The results of quantitative analysis for joint function will be at the lowest level 3 months after THA. Rehabilitation training should be carried out as soon as possible.