髋关节置换患者躯体功能变化轨迹的潜在类别及影响因素分析

doi:10.3761/j.issn.0254-1769.2026.04.004

摘要/Abstract

摘要：

目的探讨髋关节置换患者躯体功能变化轨迹的潜在类别及影响因素，为识别术后躯体功能受限高危患者并制订针对性干预方案提供参考。方法采用便利抽样法，选取2023年11月—2024年5月于河南省某三级甲等医院骨科行髋关节置换的292例患者为调查对象。采用一般资料调查表、简易躯体能力测试、营养风险筛查2002、国际版跌倒效能量表、患者健康问卷-2、匹兹堡睡眠质量指数收集患者的基线资料，于术前、术后1个月、术后3个月、术后6个月评估躯体功能，采用潜变量增长混合模型对躯体功能轨迹分类并分析其影响因素。结果共238例髋关节置换患者完成调查，有效问卷回收率为81.51%。髋关节置换患者躯体功能轨迹分为3个潜在类别：低功能恢复不佳组（10.08%）、低功能稳步恢复组（24.79%）、高功能稳步恢复组（65.13%）。多元Logistic回归分析结果显示，年龄、疾病类型、肌少症、营养状况、睡眠质量、跌倒恐惧及抑郁是髋关节置换患者躯体功能变化轨迹潜在类别的影响因素（P<0.05）。结论髋关节置换患者的躯体功能轨迹存在群体异质性，护士应重视年龄较大、髋部骨折、肌少症、营养状况较差、睡眠质量较低、存在跌倒恐惧及抑郁水平较高患者的躯体功能，给予针对性的健康宣教和护理。

关键词: 关节成形术, 置换, 髋, 躯体功能, 影响因素分析, 潜在类别分析, 护理

Abstract:

Objective To explore the latent classes and influencing factors of physical function trajectories in hip arthroplasty patients，and provide references for identifying high-risk patients with physical function limitations after surgery and developing targeted interventions. Methods A total of 292 patients who underwent hip arthroplasty in the orthopedics department of a tertiary hospital in Henan Province between November 2023 and May 2024 were enrolled via convenience sampling. Baseline data were collected using a general information questionnaire，Short Physical Performance Battery（SPPB），Nutrition Risk Screening 2002（NRS2002），Falls Efficacy Scale-International（FES-I），Patient Health Questionnaire-2（PHQ-2），and Pittsburgh Sleep Quality Index（PSQI）. Physical function levels were assessed preoperatively，and at 1 month，3 months，and 6 months postoperatively. Latent growth mixture modeling（LGMM） was used to classify trajectory patterns and identify influencing factors. Results A total of 238 patients completed the study，and the final questionnaire recovery rate was 81.51%. Physical function trajectories were categorized into 3 latent classes：low-functioning with poor recovery（10.08%），low-functioning with steady recovery”（24.79%），and high-functioning with steady recovery（65.13%）. The results of Logistic regression analysis showed that age，disease type，sarcopenia，nutritional status，sleep quality，fear of falling，and depression were influencing factors of the latent classes of physical function trajectories in hip arthroplasty patients（P<0.05）. Conclusion Physical function trajectories within 6 months after hip arthroplasty shows population heterogeneity. Nurses should pay attention to the elderly，hip fracture，sarcopenia，poor nutrition，poor sleep quality，fear of falling，and depression. Targeted measures should be strengthened.

Key words: Arthroplasty, Replacement, Hip, Physical Function, Root Cause Analysis, Latent Class Analysis, Nursing Care

王鑫, 徐慧萍, 黄倩, 孙义芳, 郭子鑫, 张昕雨. 髋关节置换患者躯体功能变化轨迹的潜在类别及影响因素分析[J]. 中华护理杂志, 2026, 61(4): 460-466.

WANG Xin, XU Huiping, HUANG Qian, SUN Yifang, GUO Zixin, ZHANG Xinyu. Analysis of latent classes and influencing factors for physical function trajectories in hip arthroplasty patients[J]. Chinese Journal of Nursing, 2026, 61(4): 460-466.

图/表 5

表1 髋关节置换患者的一般资料及其躯体功能变化轨迹潜在类别的单因素分析

Table 1 Univariate analysis of general date and latent classes of physical function trajectories among study participants

表2 髋关节置换患者不同时间点躯体功能得分（n=238，分，$\bar{x}\pm s$）

Table 2 Physical function scores at different stage of T0~T3（n=238，scores，$\bar{x}\pm s$）

表3 髋关节置换患者躯体功能变化轨迹增长混合模型拟合指标（n=238）

Table 3 Growth mixture model fitting index of development trajectory of physical function in patients with hip arthroplasty（n=238）

图1 髋关节置换患者躯体功能潜在类别增长模型轨迹

Figure 1 Growth mixture model development trajectory of physical function in patients with hip arthroplasty

表4 髋关节置换患者躯体功能变化轨迹类别的多元Logistic回归分析结果（n=238）

Table 4 Results of multivariate Logistic regression analysis for latent classes of physical function trajectory in patients with hip arthroplasty（n=238）

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