老年股骨头坏死髋关节置换术后康复应用多维度干预

doi:10.3877/cma.j.issn.1674-134X.2024.03.003

目的

探讨以结局为导向的多维度干预在老年股骨头坏死（ONFH）患者髋关节置换术后康复期的应用效果。

方法

选取2020年11月至2021年11月在首都医科大学附属北京友谊医院经影像学确诊为骨股头坏死晚期且首次且单侧行全髋关节置换术的86例ONFH患者。排除合并其他髋部疾病、肢体功能障碍，以及精神心理疾病、恶性肿瘤和重要器官功能不全的患者。按照随机数字法分为对照组和观察组各43例。对照组给予常规干预，观察组给予以结局为导向的多维度干预。分析并比较两组干预前后疼痛视觉模拟量表（VAS）、髋关节功能评分表（Harris）、汉密顿抑郁量表（HAMD）、汉密顿焦虑量表（HAMA）评分情况及两组首次下床时间、住院时间及术后并发症发生情况。计量资料组间比较采用独立样本t检验，组内比较采用配对样本t检验。计数资料采用卡方检验。

结果

与干预前相比，两组干预后VAS评分、HAMD评分、HAMA评分均降低（t=3.963、3.624、4.325、3.698、4.524、3.597，均为P<0.05），且观察组均低于对照组（t=3.246、3.562、4.304，均为P<0.05）；与干预前相比，干预后两组Harris评分均升高（t=16.542、13.624，均为P<0.05），且观察组高于对照组（t=5.642，P<0.05）；观察组首次下床时间与住院时间均短于对照组（t=3.032、3.674，均为P<0.05），术后并发症总发生率低于对照组（χ²=5.108，P<0.05）。

结论

以结局为导向的多维度干预可缓解老年ONFH髋关节置换术后患者疼痛程度和焦虑抑郁情绪，改善髋关节功能，降低术后并发症发生率加快术后康复。

关键词: 股骨头坏死, 关节成形术，置换，髋

Objective

To explore the effect of outcome oriented multi-dimensional intervention in the rehabilitation period of elderly patients with osteonecrosis of the femoral head (ONFH) after hip replacement.

Methods

Eighty-six patients with ONFH who were diagnosed with advanced necrosis of the femoral head through imaging at Beijing Friendship Hospital affiliated with Capital Medical University from November 2020 to November 2021 and underwent unilateral total hip replacement surgery for the first time were selected. The patients with other hip disease, dysfunction of limbs, mental diseases, tumors and insufficiency of vital organs were excluded. According to the random number method, the enrolled patients were divided into the control group and the observation group, 43 cases in each group. The control group received routine intervention, while the observation group received outcome oriented multidimensional intervention. The visual analog scale (VAS) for pain, Harris hip function scale (Harris), Hamilton depression scale (HAMD), and Hamilton anxiety scale (HAMA) before and after intervention between two groups were analyzed, as well as the first time of getting out of bed, length of hospital stay, and incidence of postoperative complications. Independent sample t test was used for inter group comparison of quantitative data, and paired sample t test was used for intra group comparison. The counting data analysis adopted chi square test.

Results

Compared with the data before intervention, VAS score, HAMD and HAMA scores of both groups decreased after intervention (t=3.963, 3.624, 4.325, 3.698, 4.524, 3.597, all P<0.05); and the data of observation group were lower than the control group (t=3.246, 3.562, 4.304, all P<0.05). Compared with before intervention, the Harris scores of both groups increased after intervention (t=16.542, 13.624, both P<0.05); and the data of observation group was higher than the control group (t=5.642, P<0.05). The first time of getting out of bed and hospitalization time in the observation group were shorter than those in the control group (t=3.032, 3.674, both P<0.05), and the total incidence of postoperative complications was lower than that in the control group (χ²=5.108, P<0.05).

Conclusion

Outcome oriented multidimensional interventions can alleviate the pain level, anxiety, and depression of elderly ONFH hip replacement patients, improve hip joint function, reduce the incidence of postoperative complications, and accelerate postoperative recovery.

Key words: Femur head necrosis, Arthroplasty, replacement, hip

表1 两组患者一般资料比较

Table 1 Comparison of the general data of the two groups of patients

组别 Groups	例数 Number of cases	性别 Gender		年龄［岁，（）］ Age (year)	身体质量指数［kg/m²，（）］ Body mass index	病程［年，（）］ Disease course (year)	国际骨循环学会分期 International Society of Bone Circulation staging
组别 Groups	例数 Number of cases	男 Male	女 Female	年龄［岁，（）］ Age (year)	身体质量指数［kg/m²，（）］ Body mass index	病程［年，（）］ Disease course (year)	Ⅲ期 Phase Ⅲ	Ⅳ期 Phase Ⅳ
对照组 Control group	43	28	15	61.6±5.1	22.2±2.2	3.3±0.5	19	24
观察组 Observation group	43	26	17	60.0±5.1	22.5±2.3	3.5±0.6	16	27
统计值 Statistical value		χ²=0.199		t=0.504	t=0.610	t=0.129	χ²=0.434
P值		>0.05		>0.05	>0.05	>0.05	>0.05

表1 两组患者一般资料比较

Table 1 Comparison of the general data of the two groups of patients

组别 Groups	例数 Number of cases	性别 Gender		年龄［岁，（）］ Age (year)	身体质量指数［kg/m²，（）］ Body mass index	病程［年，（）］ Disease course (year)	国际骨循环学会分期 International Society of Bone Circulation staging
组别 Groups	例数 Number of cases	男 Male	女 Female	年龄［岁，（）］ Age (year)	身体质量指数［kg/m²，（）］ Body mass index	病程［年，（）］ Disease course (year)	Ⅲ期 Phase Ⅲ	Ⅳ期 Phase Ⅳ
对照组 Control group	43	28	15	61.6±5.1	22.2±2.2	3.3±0.5	19	24
观察组 Observation group	43	26	17	60.0±5.1	22.5±2.3	3.5±0.6	16	27
统计值 Statistical value		χ²=0.199		t=0.504	t=0.610	t=0.129	χ²=0.434
P值		>0.05		>0.05	>0.05	>0.05	>0.05

表2 干预前后疼痛程度、髋关节功能［分，（

）］

Table 2 Pain severity and hip joint function before and after intervention

组别 Groups	例数 Number of cases	VAS评分 VAS score		Harris评分 Harris score
组别 Groups	例数 Number of cases	干预前 Before intervention	干预后 After intervention	干预前 Before intervention	干预后 After intervention
对照组 Control group	43	7.61±1.31	1.63±0.22^a	28.13±5.48	84.26±10.54^a
观察组 Observation group	43	7.25±1.26	4.32±0.27^a	28.54±5.51	78.18±9.82^a
t值		0.352	3.246	0.346	5.462
P值		>0.05	0.006	>0.05	<0.001

表2 干预前后疼痛程度、髋关节功能［分，（

）］

Table 2 Pain severity and hip joint function before and after intervention

组别 Groups	例数 Number of cases	VAS评分 VAS score		Harris评分 Harris score
组别 Groups	例数 Number of cases	干预前 Before intervention	干预后 After intervention	干预前 Before intervention	干预后 After intervention
对照组 Control group	43	7.61±1.31	1.63±0.22^a	28.13±5.48	84.26±10.54^a
观察组 Observation group	43	7.25±1.26	4.32±0.27^a	28.54±5.51	78.18±9.82^a
t值		0.352	3.246	0.346	5.462
P值		>0.05	0.006	>0.05	<0.001

表3 干预前后抑郁和焦虑情绪［分，（

）］

Table 3 Depression and Anxiety before and after Intervention

组别 Groups	例数 Number of cases	HAMD评分 HAMD score		HAMA评分 HAMA score
组别 Groups	例数 Number of cases	干预前 Before intervention	干预后 After intervention	干预前 Before intervention	干预后 After intervention
对照组 Control group	43	15.1±1.2	5.3±1.1	18.3±3.1	8.4±1.8
观察组 Observation group	43	14.9±1.2	9.3±1.1	18.3±3.2	13.3±1.9
t值		0.372	3.562	0.342	4.304
P值		>0.05	<0.001	>0.05	<0.001

表3 干预前后抑郁和焦虑情绪［分，（

）］

Table 3 Depression and Anxiety before and after Intervention

组别 Groups	例数 Number of cases	HAMD评分 HAMD score		HAMA评分 HAMA score
组别 Groups	例数 Number of cases	干预前 Before intervention	干预后 After intervention	干预前 Before intervention	干预后 After intervention
对照组 Control group	43	15.1±1.2	5.3±1.1	18.3±3.1	8.4±1.8
观察组 Observation group	43	14.9±1.2	9.3±1.1	18.3±3.2	13.3±1.9
t值		0.372	3.562	0.342	4.304
P值		>0.05	<0.001	>0.05	<0.001

表4 首次下床时间与住院时间［d，（

）］

Table 4 First time out of bed and length of hospital stay

组别 Groups	例数 Number of cases	首次下床时间 First ambulant time	住院时间 Hospitalization time
对照组 Control group	43	3.0±0.5	19.3±3.9
观察组 Observation group	43	4.5±0.6	23.5±4.0
t值		3.032	3.674
P值		0.010	<0.001

表4 首次下床时间与住院时间［d，（

）］

Table 4 First time out of bed and length of hospital stay

组别 Groups	例数 Number of cases	首次下床时间 First ambulant time	住院时间 Hospitalization time
对照组 Control group	43	3.0±0.5	19.3±3.9
观察组 Observation group	43	4.5±0.6	23.5±4.0
t值		3.032	3.674
P值		0.010	<0.001

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Multidimensional intervention for postoperative rehabilitation of elderly patients with femoral head necrosis and hip replacement surgery

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Multidimensional intervention for postoperative rehabilitation of elderly patients with femoral head necrosis and hip replacement surgery