术前康复教育在全髋关节置换中的意义

摘要

目的：探讨术前康复教育在全髋关节置换(totalhiparthroplasty，THA)中的意义。方法2012年1月至2013年1月，我科行THA的患者87例，分为实验组45例和对照组42例。对照组给予常规治疗护理，实验组给予常规治疗护理外，术前由手术医师和专科护士采用图片和影像资料结合实际练习，教育患者预先掌握功能锻炼方法。记录术后两组完成主动规范功能锻炼时间、肢体周径增量值及术后并发症发生率，并比较两组各指标组间及组内的差异。结果实验组首次主动完成踝泵锻炼时间、股四头肌等长收缩时间、直腿抬高时间分别为(4.62±2.39) h、(13.33±5.88) h、(23.67±6.01) h，分别少于对照组(6.12±2.93) h、(16.02±5.89) h、(27.95±7.85) h，差异均有统计学意义( P＜0.05)；下肢周径比较，实验组与对照组在术后第1天下肢周径增量值差异无统计学意义( P＞0.05)，但两组术后第2、3、5、7天下肢周径增量值均逐渐减少，实验组分别为(3.76±0.75) cm、(3.68±0.56) cm、(3.46±0.53) cm、(3.17±0.36) cm，分别小于对照组(4.03±0.55) cm、(3.92±0.51) cm、(3.71±0.59) cm、(3.48±0.36) cm，差异均有统计学意义( P＜0.05)；实验组术后并发下肢深静脉血栓( deep vein thrombosis，DVT )1例、感染1例，对照组术后并发下肢DVT 5例、假体脱位1例、感染5例，且实验组术后并发症发生率4.5%明显低于对照组26.2%，差异有统计学意义(P＜0.05)。结论术前康复教育可使THA患者预先掌握功能锻炼的方法、术后早期主动规范康复锻炼，明显减少首次主动规范功能锻炼的时间、减轻患肢肿胀和减少并发症的发生，值得临床推广应用。%Objective To investigate the role of preoperative rehabilitation education in total hip arthroplasty ( THA ).Methods From January 2012 to January 2013, 87 patients receiving THA were randomly divided into experimental group (n=45 ) and control group (n=42 ). The patients in the control group received conventional treatment and care. Besides that, the patients in the experimental group grasped the functional training method before the operation under the guidance of surgeons and specialist nurses by using the pictures and videos combined with practical exercises. The duration of the active and standard functional exercises for the ifrst time, incremental value of limb circumference and postoperative complication rates were recorded in both groups, and the differences between them were compared.Results The duration of the active ankle pump exercises for the ifrst time, contraction time of the musculi quadriceps femoris and straight leg raising time were ( 4.62±2.39 ) hr, ( 13.33±5.88 ) hr and ( 23.67±6.01 ) hr respectively in the experimental group, which were shorter than ( 6.12±2.93 ) hr, ( 16.02±5.89 ) hr and ( 27.95±7.85 ) hr in the control group. There were statistically signiifcant differences between the 2 groups (P<0.05 ). No statistically signiifcant differences in the incremental value of the lower limb circumference existed at 1 day after the operation between the 2 groups (P>0.05 ). However, the incremental values of the lower limb circumference were gradually reduced at 2, 3, 5 and 7 days after the operation, which was ( 3.76±0.75 ) cm, ( 3.68±0.56 ) cm, ( 3.46±0.53 ) cm and ( 3.17±0.36 ) cm in the experimental group and ( 4.03±0.55 ) cm, ( 3.92±0.51 ) cm, ( 3.71±0.59 ) cm and ( 3.48±0.36 ) cm in the control group. There were statistically significant differences between the 2 groups (P<0.05 ). There was 1 case of deep vein thrombosis ( DVT ) of the lower limb and 1 case of infections in the experimental group, and there were 5 cases of DVT of the lower limb, 1 case of prosthesis dislocation and 5 cases of infections in the control group. The postoperative complication rate was obviously lower in the experimental group ( 4.5% ) than that in the control group ( 26.2% ), and there were statistically significant differences between the 2 groups (P<0.05 ).Conclusions The preoperative rehabilitation education in THA is worthy of clinical application, with the advantages of obviously alleviated limb swelling and lower complication rates. The patients can grasp the functional training method in advance, so as to actively standardize rehabilitation exercises early.