阶梯式平衡功能训练对血友病关节置换患者平衡功能与跌倒恐惧影响的研究

doi:10.3761/j.issn.0254-1769.2026.12.002

中华护理杂志 ›› 2026, Vol. 61 ›› Issue (12): 1597-1603.DOI: 10.3761/j.issn.0254-1769.2026.12.002

阶梯式平衡功能训练对血友病关节置换患者平衡功能与跌倒恐惧影响的研究

张燕¹(), 翁习生¹, 刘玮楠², 霍晓鹏³, 张琳¹, 宋亚君¹, 李爽¹, 宋申敏¹, 奉爱萍¹, 佟冰渡¹^,^*()

¹ 中国医学科学院北京协和医学院北京协和医院骨科北京市 100730
² 中国医学科学院北京协和医学院北京协和医院外科北京市 100730
³ 中国医学科学院北京协和医学院北京协和医院护理部北京市 100730

收稿日期:2025-12-30 出版日期:2026-06-20 发布日期:2026-06-12
*通讯作者: 佟冰渡，E-mail：tongbingdu@sina.com
作者简介:张燕：女，硕士，副主任护师，E-mail：zhangyan89yanli@163.com
第一联系人：作者贡献声明
张燕：研究设计、方案构建、经费支持、论文撰写；翁习生：方案构建；刘玮楠、霍晓鹏：研究指导；张琳、宋亚君、李爽、宋申敏、奉爱萍：研究实施、数据收集与整理；佟冰渡：研究指导、论文审阅与修改、方案构建
基金资助:
中国医学科学院北京协和医院护理科研课题(XHHLKY202406)

Study on the effect of balance training on balance function and fear of falling in patients after hemophilia hip and knee arthroplasty

ZHANG Yan¹(), WENG Xisheng¹, LIU Weinan², HUO Xiaopeng³, ZHANG Lin¹, SONG Yajun¹, LI Shuang¹, SONG Shenmin¹, FENG Aiping¹, TONG Bingdu¹^,^*()

¹ Department of Orthopedics， Peking Union Medical College Hospital，Chinese Academy of Medical Sciences & Peking Union Medical College， Beijing 100730， China
² Surgery Department， Peking Union Medical College Hospital，Chinese Academy of Medical Sciences & Peking Union Medical College， Beijing 100730， China
³ Nursing Department， Peking Union Medical College Hospital，Chinese Academy of Medical Sciences & Peking Union Medical College， Beijing 100730， China

Received:2025-12-30 Online:2026-06-20 Published:2026-06-12
* Corresponding author: TONG Bingdu，E-mail：tongbingdu@sina.com
Funding program:
Nursing Research Project of Peking Union Medical College Hospital(XHHLKY202406)

摘要/Abstract

摘要：

目的探讨阶梯式平衡功能训练对血友病性骨关节病患者行关节置换术后平衡功能与跌倒恐惧的影响，为临床护理干预提供参考。方法采用方便抽样法，选取2024年11月—2025年10月在北京市某三级甲等医院骨科住院的43例血友病性骨关节病患者作为试验组，接受常规护理与为期12周的阶梯式平衡功能训练；2023年11月—2024年10月住院的38例患者为对照组，接受常规护理。在术前、术后首次下床、出院当天、术后6周及术后12周，使用Berg平衡量表（Berg Balance Scale，BBS）、修订版跌倒恐惧问卷（Fear of Falling Questionnaire-Revised，FFQ-R）和血友病功能独立性评分（Functional Independence Score in Hemophilia，FISH）进行评价。结果两组均无失访病例。两组BBS、FFQ-R、FISH评分组间和时间的交互效应差异有统计学意义（P<0.05）；简单效应分析显示，在术后6周和术后12周时，试验组的BBS评分和FISH评分高于对照组，FFQ-R评分低于对照组，差异均具有统计学意义（P<0.05）。结论阶梯式平衡功能训练能够有效改善血友病性骨关节病患者关节置换术后的平衡功能，提升患者的日常活动能力，降低其跌倒恐惧心理。

关键词: 血友病, 关节置换术, 平衡功能训练, 跌倒恐惧, 护理

Abstract:

Objective To investigate the effects of stepwise balance training on balance function and fear of falling in patients with hemophilic arthropathy after hip and knee arthroplasty，and to provide references for clinical nursing interventions. Methods A convenience sampling method was employed to select 81 patients with hemophilic arthropathy from the Department of Orthopedics of a tertiary Grade A hospital in Beijing from November 2023 to October 2025 as the study subjects. From November 2024 to October 2025，43 patients were assigned to an experimental group，who received routine nursing combined with 12 weeks of stepwise balance training；38 patients from November 2023 to October 2024 were assigned to a control group，who received routine nursing. Assessments were conducted at preoperative，first postoperative ambulation，discharge day，6 weeks postoperatively，and 12 weeks postoperatively using the Berg Balance Scale（BBS），the Fear of Falling Questionnaire-Revised（FFQ-R），and the Functional Independence Score in Hemophilia（FISH）. Results No cases were lost to follow-up in either group. The differences in BBS，FFQ-R，and FISH scores between the 2 groups and the interaction effects over time were statistically significant（P<0.05）. At 6 weeks and 12 weeks postoperatively，the BBS and FISH scores in the experimental group were higher than those in the control group，while the FFQ-R score was lower，with all differences being statistically significant（P<0.05）. Conclusion Stepwise balance training effectively improves postoperative balance function，enhances daily activity capacity，and reduces fear of falling in patients with hemophilic arthritis undergoing hip and knee arthroplasty.

Key words: Hemophilia, Arthroplasty, Balance Function Training, Fear of Falling, Nursing Care

张燕, 翁习生, 刘玮楠, 霍晓鹏, 张琳, 宋亚君, 李爽, 宋申敏, 奉爱萍, 佟冰渡. 阶梯式平衡功能训练对血友病关节置换患者平衡功能与跌倒恐惧影响的研究[J]. 中华护理杂志, 2026, 61(12): 1597-1603.

ZHANG Yan, WENG Xisheng, LIU Weinan, HUO Xiaopeng, ZHANG Lin, SONG Yajun, LI Shuang, SONG Shenmin, FENG Aiping, TONG Bingdu. Study on the effect of balance training on balance function and fear of falling in patients after hemophilia hip and knee arthroplasty[J]. Chinese Journal of Nursing, 2026, 61(12): 1597-1603.

图/表 4

表1 两组一般资料的比较

Table 1 Comparison of general data between the 2 groups

表2 两组不同时间平衡能力的比较（分，$\bar{x}±s$）

Table 2 Comparison of BBS at different time points between the 2 groups

表3 两组不同时间跌倒恐惧水平的比较（分，$\bar{x}±s$）

Table 3 Comparison of FFQ-R at different time points between the 2 groups（scores，$\bar{x}±s$）

表4 两组不同时间日常活动能力的比较（分，$\bar{x}±s$）

Table 4 Comparison of FISH at different time points between the 2 groups（scores，$\bar{x}±s$）

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阶梯式平衡功能训练对血友病关节置换患者平衡功能与跌倒恐惧影响的研究

Study on the effect of balance training on balance function and fear of falling in patients after hemophilia hip and knee arthroplasty

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