老年髋部骨折术后应用整合性康复技术的疗效分析

doi:10.3877/cma.j.issn.1674-134X.2026.04.003

目的

基于倾向性评分匹配（PSM）分析足踝功能训练器联合视觉反馈平衡功能训练在老年髋部骨折患者术后运动能力中的影响。

方法

选取2022年12月至2024年6月期间徐州市中心医院收治的120例老年髋部骨折术后患者为研究对象，纳入标准：（1）年龄≥60岁；（2）临床影像学诊断为髋部骨折；（3）在院期间接受针对髋部骨折的手术治疗。排除标准：（1）肿瘤、甲状旁腺功能亢进等引起的病理性骨折；（2）并存其他部位骨折或既往行髋部手术；（3）严重神经系统疾病或痴呆；（4）临床资料不完整。根据不同训练方法将患者分为联合组（n=52）和对照组（n=68），使用PSM进行1∶1匹配后，每组46例。其中，联合组接受足踝功能训练器联合视觉反馈平衡功能训练，对照组接受单一足踝功能训练器训练。对比两组患者治疗前后的Fugl-Meyer运动功能评定量表下肢部分量表（FMA-L）、Harris髋关节功能评分（HHS-F）、Berg平衡量表（BBS）的差异。计数资料以例数（n）和百分率（%）表示，进行卡方检验；经检验符合正态分布的计量资料采用

x ¯

±s表示，组间比较采用独立样本t检验。

结果

经PSM，两组患者的基线资料差异无统计学意义（均为P＞0.05）。干预8周后，两组患者的FMA-L评分均高于干预前，且联合组（33.1±3.1）分高于对照组（22.0±3.0）分（t=17.448，P＜0.05）；两组患者的HHS-F评分均高于干预前，且联合组HHS-F评分（85±5）分及其评分优良率（89.1%）均高于对照组（82±5）分和（78.3%）（t=2.788，P＜0.05）；两组患者BBS评分均高于干预前，联合组为（45.5±3.5）分高于对照组（33.8±3.2）分（t=16.666，P＜0.05）。

结论

足踝功能训练器联合视觉反馈平衡功能训练可有效改善老年髋部骨折患者术后运动能力以及平衡功能，PSM分析支持其效果可靠性，具有临床推广价值。

关键词: 倾向性评分, 配对分析, 足, 踝, 康复, 反馈，感觉, 老年人, 髋骨折

Objective

To analyse the effect of foot and ankle functional trainer combined with visual feedback balance function training in postoperative motor ability of elderly hip fracture patients based on propensity score matching (PSM).

Methods

From December 2022 to June 2024, 120 elderly patients with hip fractures who were admitted to Xuzhou Central Hospital were selected as the research subjects. Inclusion criteria: (1) age ≥60 years; (2) clinically diagnosed with hip fractures through imaging; (3) received surgical treatment for hip fractures during their hospital stay. Exclusion criteria: (1) pathological fractures caused by tumors, hyperparathyroidism, etc.; (2) concurrent fractures in other parts or previous hip surgeries; (3) severe neurological diseases or dementia; (4) incomplete clinical data. The patients were divided into the combined group (n=52) and the control group (n=68) based on different training methods. After 1∶1 matching using PSM, 46 patients were in each group. Among them, the combined group received combined training with a foot and ankle functional trainer and visual feedback balance function training, while the control group received training with a single foot and ankle functional trainer. The differences in the lower limb part of the Fugl-Meyer motor function rating scale (FMA-L), Harris hip fuction score (HHS-F), and Berg balance scale (BBS) before and after treatment were compared between the two groups. Count data were expressed as the number of cases (n) and rate (%), and chi square test was performed; for data that met normal distribution, they were expressed using and independent sample t test was used for group comparison.

Results

After PSM, there was no statistically significant difference in the baseline data between the two groups (all P>0.05). After eight weeks of intervention, the FMA-L scores of both groups were higher than those before the intervention, and the combined group (33.1±3.1) points were higher than the control group (22.0±3.0) points (t=17.448, P<0.05); the HHS-F scores of both groups were higher than those before the intervention, and the HHS-F score of the combined group (85±5) points and its excellent rate (89.1%) were higher than those of the control group (82±5) points, (78.3%) (t=2.788, P<0.05); the BBS scores of both groups were higher than those before the intervention, and the combined group was (45.5±3.5) points higher than the control group (33.8±3.2) points (t=16.666, P<0.05).

Conclusion

Foot and ankle functional trainer combined with visual feedback balance function training can effectively improve the postoperative motor ability as well as balance function of elderly hip fracture patients, and PSM analysis supports the reliability of its effect, which has clinical promotion value.

Key words: Propensity score, Matched-pair analysis, Foot, Ankle, Rehabilitation, Feedback, sensory, Aged, Hip fracture

表1 PSM前两组基线资料比较

Table 1 Comparison of baseline data between the first two groups before PSM

因素 Factors	联合组 Combined group	对照组 Control group	统计值 Statistical values	P值
例数 Number of cases	52	68
性别［n（%）］ Gender
男Male	13（25.0）	20（29.4）	χ²=0.288	＞0.05
女Female	39（75.0）	48（70.6）	χ²=0.288	＞0.05
年龄［岁，（ $x ¯$ ±s）］ Age（year）	70.6±8.7	68.5±4.8	t=1.681	＞0.05
BMI［kg/m²，（ $x ¯$ ±s）］	24.1±2.7	23.2±2.1	t=2.069	＜0.05
术前骨密度［g/cm²，（ $x ¯$ ±s）］ Bone mineral density before surgery	2.3±1.3	2.7±1.6	t=1.199	＞0.05
白蛋白［g/L，（ $x ¯$ ±s）］ Albumin	36.9±6.5	32.2±6.1	t=4.058	＜0.001
血红蛋白［g/L，（ $x ¯$ ±s）］ Hemoglobin	105.6±11.6	94.3±8.7	t=6.119	＜0.001
合并症［n（%）］ Complications
有Yes	10（19.2）	18（26.5）	χ²=0.863	＞0.05
无No	42（80.8）	50（73.5）	χ²=0.863	＞0.05

表1 PSM前两组基线资料比较

Table 1 Comparison of baseline data between the first two groups before PSM

因素 Factors	联合组 Combined group	对照组 Control group	统计值 Statistical values	P值
例数 Number of cases	52	68
性别［n（%）］ Gender
男Male	13（25.0）	20（29.4）	χ²=0.288	＞0.05
女Female	39（75.0）	48（70.6）	χ²=0.288	＞0.05
年龄［岁，（ $x ¯$ ±s）］ Age（year）	70.6±8.7	68.5±4.8	t=1.681	＞0.05
BMI［kg/m²，（ $x ¯$ ±s）］	24.1±2.7	23.2±2.1	t=2.069	＜0.05
术前骨密度［g/cm²，（ $x ¯$ ±s）］ Bone mineral density before surgery	2.3±1.3	2.7±1.6	t=1.199	＞0.05
白蛋白［g/L，（ $x ¯$ ±s）］ Albumin	36.9±6.5	32.2±6.1	t=4.058	＜0.001
血红蛋白［g/L，（ $x ¯$ ±s）］ Hemoglobin	105.6±11.6	94.3±8.7	t=6.119	＜0.001
合并症［n（%）］ Complications
有Yes	10（19.2）	18（26.5）	χ²=0.863	＞0.05
无No	42（80.8）	50（73.5）	χ²=0.863	＞0.05

表2 PSM后两组基线资料比较

Table 2 Comparison of baseline data between the two groups after PSM

因素 Factors	联合组 Combined group	对照组 Control group	统计值 Statistical values	P值
例数 Number of cases	46	46
性别［n（%）］ Gender
男Male	17（37.0）	15（32.6）	χ²=0.192	＞0.05
女Female	29（63.0）	31（67.7）	χ²=0.192	＞0.05
年龄［岁，（ $x ¯$ ±s）］ Age（year）	69.9±7.2	69.3±5.7	t=0.412	＞0.05
BMI［kg/m²，（ $x ¯$ ±s）］	24.0±2.3	23.5±2.1	t=1.110	＞0.05
术前骨密度［g/cm²，（ $x ¯$ ±s）］ Bone mineral density before surgery	2.4±1.3	2.6±1.5	t=0.724	＞0.05
白蛋白［g/L，（ $x ¯$ ±s）］ Albumin	35.4±6.3	35.4±6.2	t=0.039	＞0.05
血红蛋白［g/L，（ $x ¯$ ±s）］ Hemoglobin	107.0±11.4	105.7±10.4	t=0.558	＞0.05
合并症［n（%）］ Complications
有Yes	11（23.9）	13（28.3）	χ²=0.226	＞0.05
无No	35（76.1）	33（71.7）	χ²=0.226	＞0.05

表2 PSM后两组基线资料比较

Table 2 Comparison of baseline data between the two groups after PSM

因素 Factors	联合组 Combined group	对照组 Control group	统计值 Statistical values	P值
例数 Number of cases	46	46
性别［n（%）］ Gender
男Male	17（37.0）	15（32.6）	χ²=0.192	＞0.05
女Female	29（63.0）	31（67.7）	χ²=0.192	＞0.05
年龄［岁，（ $x ¯$ ±s）］ Age（year）	69.9±7.2	69.3±5.7	t=0.412	＞0.05
BMI［kg/m²，（ $x ¯$ ±s）］	24.0±2.3	23.5±2.1	t=1.110	＞0.05
术前骨密度［g/cm²，（ $x ¯$ ±s）］ Bone mineral density before surgery	2.4±1.3	2.6±1.5	t=0.724	＞0.05
白蛋白［g/L，（ $x ¯$ ±s）］ Albumin	35.4±6.3	35.4±6.2	t=0.039	＞0.05
血红蛋白［g/L，（ $x ¯$ ±s）］ Hemoglobin	107.0±11.4	105.7±10.4	t=0.558	＞0.05
合并症［n（%）］ Complications
有Yes	11（23.9）	13（28.3）	χ²=0.226	＞0.05
无No	35（76.1）	33（71.7）	χ²=0.226	＞0.05

表3 两组髋部FMA-L评分比较（

x ¯

±s）

Table 3 Comparison of FMA-L score in the hip area between the two groups

组别 Groups	例数 Number of cases	干预前 Before intervention	干预后 After intervention	t值	P值
对照组 Control group	46	16.2±1.2	22.0±3.0	12.027	＜0.001
联合组 Combined group	46	16.2±1.5	33.1±3.1	17.448	＜0.001
t值		0.141	17.448	-	-
P值		＞0.05	＜0.001	-	-

表3 两组髋部FMA-L评分比较（

x ¯

±s）

Table 3 Comparison of FMA-L score in the hip area between the two groups

组别 Groups	例数 Number of cases	干预前 Before intervention	干预后 After intervention	t值	P值
对照组 Control group	46	16.2±1.2	22.0±3.0	12.027	＜0.001
联合组 Combined group	46	16.2±1.5	33.1±3.1	17.448	＜0.001
t值		0.141	17.448	-	-
P值		＞0.05	＜0.001	-	-

表4 两组HHS-F比较（

x ¯

±s）

Table 4 Comparison of HHS-F between two groups

组别 Groups	例数 Number of cases	干预前 Before intervention	干预后 After intervention	干预后优良率（%） Excellent-good rate after intervention	t值	P值
对照组 Control group	46	44±5	82±5	36（78.3）	35.997	＜0.001
联合组 Combined group	46	45±4	85±5	41（89.1）	41.269	＜0.001
统计值 Statistical values		t=0.761	t=2.788	χ²=1.991	-	-
P值		＞0.05	＜0.01	＞0.05	-	-

表4 两组HHS-F比较（

x ¯

±s）

Table 4 Comparison of HHS-F between two groups

组别 Groups	例数 Number of cases	干预前 Before intervention	干预后 After intervention	干预后优良率（%） Excellent-good rate after intervention	t值	P值
对照组 Control group	46	44±5	82±5	36（78.3）	35.997	＜0.001
联合组 Combined group	46	45±4	85±5	41（89.1）	41.269	＜0.001
统计值 Statistical values		t=0.761	t=2.788	χ²=1.991	-	-
P值		＞0.05	＜0.01	＞0.05	-	-

表5 两组BBS评分比较（

x ¯

±s）

Table 5 Comparison of BBS scores between the two groups

组别 Groups	例数 Number of cases	干预前 Before intervention	干预后 After intervention	t值	P值
对照组 Control group	46	18.7±3.9	33.8±3.2	20.454	＜0.001
联合组 Combined group	46	18.2±2.3	45.5±3.5	43.988	＜0.001
t值		0.692	16.666	-	-
P值		＞0.05	＜0.001	-	-

表5 两组BBS评分比较（

x ¯

±s）

Table 5 Comparison of BBS scores between the two groups

组别 Groups	例数 Number of cases	干预前 Before intervention	干预后 After intervention	t值	P值
对照组 Control group	46	18.7±3.9	33.8±3.2	20.454	＜0.001
联合组 Combined group	46	18.2±2.3	45.5±3.5	43.988	＜0.001
t值		0.692	16.666	-	-
P值		＞0.05	＜0.001	-	-

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Efficacy analysis of integrative rehabilitation techniques applied after hip fracture surgery in elderly patients

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Efficacy analysis of integrative rehabilitation techniques applied after hip fracture surgery in elderly patients