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

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