全髋关节置换术后患者渐进式平衡训练方案的制订与应用

doi:10.3761/j.issn.0254-1769.2020.10.003

摘要/Abstract

摘要：

目的制订渐进式平衡训练方案,并探讨其在全髋关节置换术后患者康复早期中的应用效果。方法通过循证检索、院内修订、预试验等环节,制订全髋关节置换术后渐进式平衡训练方案。便利抽取2019年1月—8月入住苏州市某三级甲等医院骨伤科,首次行全髋关节置换术患者65例,依据床位安排分为试验组36例,对照组29例。试验组在常规锻炼的基础上给予渐进式平衡训练方案,对照组采用常规锻炼方案。使用Berg平衡量表、起立行走计时测试、中文版跌倒效能量表测量并比较两组干预前,术后1周、2周、4周、8周的康复效果。结果重复测量方差分析结果显示,术后两组Berg平衡量表评分与起立行走计时测试评分的时间效应、交互效应、组间效应均具有统计学意义（F_时间=1 645.43,F_交互=73.51,F_组间=761.72;F_时间=4 289.34,F_交互=72.83,F_组间=231.43,均P<0.05）。非参数检验结果显示,两组术后4周、8周的中文版跌倒效能量表评分比较,差异均有统计学意义（Z=-4.09,P<0.001;Z=-2.65,P<0.01）。结论渐进式平衡训练方案可加速全髋关节置换术后患者康复早期平衡能力、行走能力的恢复,提高患者跌倒效能,改善患者害怕跌倒的心理。

关键词: 关节成形术, 置换, 髋, 姿势平衡, 渐进式训练, 康复护理

Abstract:

Objective To develop a progressive balance training program and to explore effects of early rehabilitation after total hip arthroplasty. Methods Through evidence-based retrieval,in-hospital revision,and pre-experiment,the progressive balance training program after total hip arthroplasty was formulated. Totally 65 patients under total hip arthroplasty in the Department of Orthopedic Trauma,a tertiary hospital in Suzhou,were included from January to August 2019 by convenient sampling,with 36 patients in an experimental group and 29 patients in a control group by bed arrangement. The experimental group was given the progressive balance training on the basis of routine exercise,while the control group was given a routine exercise program. The Berg Balance Scale（BBS）,the Time Up and Go Test（TUGT）,and Modified Fall Efficacy Scale（MFES） were used to measure and compare the differences of rehabilitation between 2 groups at 1,2,4 and 8 weeks after operation. Results The results of repeated measurement analysis of variance showed that the time,interaction and inter group effects of BBS and TUGT were statistically significant（F_time=1 645.43,F_{time × group}=73.51,F_group=761.72;F_time=4 289.34,F_{time × group}=72.83,F_group=231.43,P<0.05）. Non-parametric test showed that there were significant differences in MFES scores between 2 groups at 4 and 8 weeks after operation（Z=-4.09,P<0.001;Z=-2.65,P<0.01）. Conclusion The progressive balance training program can accelerate the recovery of balance ability and walking ability of patients in the early stage of rehabilitation after total hip arthroplasty,improve fall efficiency of patients,and improve fear of falling of patients.

Key words: Arthroplasty, Replacement, Hip, Postural Balance, Progressive Training, Rehabilitation Nursing

谷斌,陈绪娜,张千坤,张丽娟,马茜,俞红,陈咏真,骆丽. 全髋关节置换术后患者渐进式平衡训练方案的制订与应用[J]. 中华护理杂志, 2020, 55(10): 1458-1464.

GU Bin,CHEN Xuna,ZHANG Qiankun,ZHANG Lijuan,MA Qian,YU Hong,CHEN Yongzhen,LUO Li. Formulation and application of a progressive balance training program after total hip arthroplasty[J]. Chinese Journal of Nursing, 2020, 55(10): 1458-1464.

图/表 4

表1 两组一般资料的比较

Table 1 Baseline information of participants in 2 groups

表2 两组不同时间点Berg平衡量表评分比较（分,$\bar{x}$±s）

Table 2 BBS scores at different time points in 2 groups（scores,$\bar{x}$±s）

表3 两组不同时间点起立行走6 m计时测试比较（$\bar{x}$±s）

Table 3 TUGT scores at different time points in 2 groups（$\bar{x}$±s）

表4 两组各时间点中文版跌倒效能量表评分比较[分,M（P25,P75）]

Table 4 MFES scores at different time points in 2 groups[scores,M（P25,P75）]

参考文献 23

[1]	李庆涛, 徐东潭, 徐光辉. 临床骨科康复治疗学[M]. 北京: 科学技术文献出版社, 2009: 478.
	Li QT, Xu DT, Xu GH. Clinical orthopedics rehabilitation therapy[M]. Beijing: Science and Technical Documentation Press, 2009: 478.
[2]	戴尅戎, 李慧武, 严孟宁. 我国人工关节加速发展的二十年[J]. 中华关节外科杂志(电子版), 2015,9(6):691-694.
	Dai KR, Li HW, Yan MN. Twenty-year accelerated development of artificial joints in China[J]. Chin J Joint Surg(Electronic Edition), 2015,9(6):691-694.
[3]	Cioppa-Mosca, Cahill B, Cavanaugh T, et al. 骨科术后康复指南[M]. 天津: 天津科技翻译出版公司, 2009: 16-29.
	Cioppa-Mosca, Cahill B, Cavanaugh T, et al. Orthopedic rehabilitation guidelines[M]. TianJin:TianJin Science and technology translation and publishing company, 2009: 16-29.
[4]	沈良册, 吴立红, 朱江军, 等. 等速-平衡-减重综合康复训练对老年人髋关节置换术后的疗效分析[J]. 中国康复理论与实践, 2010,16(11):1008-1009.
	Shen LC, Wu LH, Zhu JJ, et al. Effect of Isokinetic,Balance,Weight-support training on senile patients after total kip arthroplasty[J]. Chin J Rehabil Theory Pract, 2010,16(11):1008-1009.
[5]	王纪云, 王应琼, 梁小青, 等. 平衡功能训练在单侧髋关节置换术后下肢运动功能重建中的应用[J]. 护理实践与研究, 2017,14(4):40-43.
	Wang JY, Wang YQ, Liang XQ, et al. Application of balance function training in lower limb motor function reconstruction after unilateral hip arthroplasty[J]. Nurs Prac Res, 2017,14(4):40-43.
[6]	Jogi P, Overend TJ, Spaulding SJ, et al. Effectiveness of balance exercises in the acute post-operative phase following total hip and knee arthroplasty:a randomized clinical trial[J]. SAGE Open Med, 2015,3:1-9.
[7]	杨虹, 赵巧玉. 奥塔戈运动在老年全髋关节置换术患者出院后跌倒管理中的应用[J]. 护理管理杂志, 2016,16(3):192-194.
	Yang H, Zhao QY. The effects of Otago Exercise Program in fall management for discharged elderly patients with total hip replacement[J]. J Nurs Admin, 2016,16(3):192-194.
[8]	Nicholson VP, McKean MR, Burkett BJ, Twelve weeks of BodyBalance training improved balance and functional task performance in middle-aged and older adults[J]. Clin Interv Aging, 2014,9:1895-1904. DOI URL PMID
[9]	Campbell AJ, Robertson MC, Gardner MM, et al. Randomised controlled trial of a general practice programme of home based exercise to prevent Falls in elderly women[J]. BMJ, 1997,315(7115):1065-1069. DOI URL PMID
[10]	Fisseha B, Janakiraman B, Yitayeh A, et al., Effect of square stepping exercise for older adults to prevent fall and injury related to fall:systematic review and meta-analysis of current evidences[J]. J Exerc Rehabil, 2017,13(1):23-29. DOI URL PMID
[11]	El-Khoury F, Cassou B, Latouche A, et al. Effectiveness of two year balance training programme on prevention of fall induced injuries in at risk women aged 75-85 living in community:Ossébo randomised controlled trial[J]. BMJ, 2015,351:h3830. DOI URL PMID
[12]	Halvarsson A, Oddsson L, Franzén E, et al. Long-term effects of a progressive and specific balance-training programme with multi-task exercises for older adults with osteoporosis:a randomized controlled study[J]. Clin Rehabil, 2016,30(11):1049-1059. DOI URL PMID
[13]	张慧鑫, 陈健新, 张瑞丽, 等. 双重任务与单一任务训练对老年人步态和平衡改善效果的Meta分析[J]. 中华护理杂志, 2019,54(9):1400-1405.
	Zhang HX, Chen JX, Zhang RL, et al. A meta-analysis of the effects of dual-task and single-task training on improvement of gait and balance in the elderly[J]. Chin J Nurs, 2019,54(9):1400-1405.
[14]	王文慧, 张利峰, 李信欣, 等. 髋关节置换术后患者不同时期关节功能变化及其影响因素研究[J]. 中华护理杂志, 2017,52(6):649-653.
	Wang WH, Zhang LF, Li XX, et al. Joint function and its influencing factors of patients underwent hip arthroplasty[J]. Chin J Nurs, 2017,52(6):649-653.
[15]	姚新苗. 中医骨伤科临床诊疗指南·人工髋关节置换围手术期康复专家共识[J]. 康复学报, 2017,27(4):1-6.
	Yao XM. Expert Consensus for rehabilitation of traditional Chinese medicine in perioperative period of total hip replacement[J]. Rehabil Med, 2017,27(4):1-6.
[16]	Berg KO, Wood-Dauphinee S, Williams JT, et al. Measuring bal-ance in the elderly:preliminary evelopment of an instrument[J]. Physiother Can, 1989,41:304-311. DOI URL
[17]	金冬梅, 燕铁斌, 曾海辉. Berg平衡量表的效度和信度研究[J]. 中国康复医学杂志, 2003,18(1):25-27.
	Jin DM, Yang TB, Zeng HH. Validity and reliability of Berg balance scale on assessing balance function[J]. Chin J Rehabil Med, 2003,18(1):25-27.
[18]	Podsiadlo D, Richardson S. The timed “Up & Go”:a test of basic functional mobility for frail elderly persons[J]. J Am Geriatr Soc, 1991,39(2):142-148. DOI URL PMID
[19]	燕铁斌. “起立-行走”计时测试简介:功能性步行能力快速定量评定法[J]. 中国康复理论与实践, 2000,6(3):19-21.
	Yan TB. A brief introduction to the timing test of "Stand-Walk"-rapid quantitative assessment of functional walking ability[J]. Chin J Rehabil Theory Pract, 2000,6(3):19-21.
[20]	郝燕萍, 刘雪琴. 修订版跌倒效能量表在我国老年人群中的测试研究[J]. 中华护理杂志, 2007,42(1):19-21.
	Hao YP, Liu XQ. Research of application of the Modified Fall Efficacy Scale of Chinese version in the aged in China[J]. Chin J Nurs, 2007,42(1):19-21.
[21]	Domínguez-Navarro F, Igual-Camacho C, Silvestre-Muñoz A, et al. Effects of balance and proprioceptive training on total hip and knee replacement rehabilitation:a systematic review and meta-analysis[J]. Gait Posture, 2018,62:68-74. DOI URL PMID
[22]	马志翔, 尹宗生, 许鹏飞, 等. 合肥地区人工髋关节置换病因及相关因素:6年5所医院3056例回顾性分析[J]. 中国组织工程研究, 2015,19(9):1352-1357.
	Ma ZX, Yin ZS, Xu PF, et al. Etiology and factors of total hip replacement in Hefei area of China:retrospective analysis on 3056 cases from 5 hospitals in 6 years[J]. J Clin Rehabil Tis Eng Res, 2015,19(9):1352-1357.
[23]	Smith TO, Pearson M, Latham SK. Are people following hip and knee arthroplasty at greater risk of experiencing a fall and fracture? Data from the Osteoarthritis Initiative[J]. Arch Orthop Trauma Surg, 2016,136(6):865-872. DOI URL PMID