Abstract:

Objective To formulate a progressive resistance training（PRT） protocol for elderly patients with hip fractures complicated by sarcopenia，and to evaluate its effectiveness and feasibility，so as to provide clinical evidence for postoperative functional rehabilitation of such patients. Methods Based on the Health Action Process Approach（HAPA） theory，a progressive resistance training program was formulated through literature review and expert panel meetings. Convenience sampling was used to recruit 80 elderly patients with hip fracture complicated by sarcopenia who underwent unilateral hip arthroplasty from July to December 2024 in the Department of Geriatrics，a tertiary Grade A hospital in Yunnan Province. All patients were randomly divided into an intervention group（odd numbers） and a control group（even numbers） using a random number table，with 40 cases in each group. The intervention group received 12-week progressive resistance training combined with routine orthopedic rehabilitation nursing，while the control group received routine orthopedic rehabilitation nursing alone. The 2 groups were compared in terms of maximum grip strength，affected lower limb muscle strength，Skeletal Muscle Mass Index（SMI），Timed Up and Go Test（TUGT） time，Harris Hip Score and rehabilitation self-efficacy score at 7 days，1 month and 3 months after surgery. Results Ultimately，38 cases in the intervention group and 39 cases in the control group completed the study. After the intervention，significant time effects and interaction effects were observed in maximum grip strength，SMI，TUGT time，Harris Hip Score，and rehabilitation self-efficacy score in both groups（P<0.001）. For affected lower limb muscle strength，significant time effects and inter-group effects were found（P<0.05）. Simple effect analysis indicated that at 3 months postoperatively，the intervention group exhibited higher levels of maximum grip strength，SMI，rehabilitation self-efficacy score，Harris Hip Score，and affected lower limb muscle strength，as well as shorter TUGT time compared with the control group，and all differences were statistically significant（P<0.001）. Conclusion The progressive resistance training protocol established in this study can effectively improve muscle mass and muscle strength，promote the functional recovery of the hip joint and lower limb functional recovery，and enhance rehabilitation self-efficacy and activities of daily lining in elderly patients with hip fracture complicated by sarcopenia.

Key words: Hip Fracture, Sarcopenia, Resistance Training, Aged, Nursing Care

摘要：

目的 构建老年髋部骨折合并肌少症患者术后渐进性抗阻训练方案，并验证其有效性和可行性，为此类患者术后功能锻炼提供临床实践依据。方法 通过文献回顾及专家会议法，构建老年髋部骨折合并肌少症患者渐进性抗阻训练方案。采用便利抽样法，选取2024年7—12月在云南省某三级甲等医院老年医学科行单侧髋关节置换术的老年髋部骨折合并肌少症患者80例作为研究对象，采用随机数字表法，将随机数中的奇数设为试验组，偶数设为对照组，两组各40例患者。试验组接受12周渐进性抗阻训练和常规骨科康复护理，对照组接受常规骨科康复护理，比较两组术后7 d、1个月、3个月的最大握力、患侧下肢肌力、骨骼肌质量指数（Skeletal Muscle Index，SMI）、起立-行走计时测试（Timed Up and Go Test，TUGT）时间、Harris髋关节功能评分及康复自我效能得分的差异。结果 试验组38例、对照组39例完成研究。干预后，两组的最大握力、SMI、TUGT时间、康复自我效能得分的时间效应及时间与组间的交互效应差异具有统计学意义（P<0.001），Harris髋关节功能评分的组间、时间及时间与组间的交互效应差异具有统计学意义（P<0.05），两组患侧下肢肌力的时间效应和组间效应差异具有统计学意义（P<0.05）。简单效应分析显示，术后3个月时试验组最大握力、SMI、康复自我效能得分、Harris髋关节功能评分及患侧下肢肌力均高于对照组，试验组的TUGT时间短于对照组，差异均具有统计学意义（P<0.05）。结论 实施该渐进性抗阻训练方案可在一定程度上改善老年髋部骨折合并肌少症患者的肌肉质量与肌力，促进髋关节及下肢功能恢复，提高康复自我效能与日常生活能力。

关键词: 髋部骨折, 肌少症, 抗阻训练, 老年人, 护理