摘要
背景:目前针对非骨水泥型全髋关节置换的康复治疗较少,且大都以遵循传统的负重限制。目的:比较早期负重和晚期负重对非骨水泥型全髋关节置换后患者功能恢复的影响,探讨制定科学与个体化康复方案的可行性。设计、时间及地点:分组对比观察,病例来自2003-04/2006-03中山大学附属一院骨科和广州市第一人民医院骨科。对象:共收集行非骨水泥型全髋关节置换患者40例(42髋),男21例,女19例,年龄32～63岁,平均50岁;符合研究入选标准的有30例(32髋)。方法:30例患者分为两组,每组15例。早期负重组:对患者进行早期负重康复治疗;晚期负重组:对患者进行晚期负重康复治疗。两组患者的治疗方案,除术后负重方法不同外,均予系统的早期康复治疗。分为术前和术后阶段,基本训练内容包括肌力和耐力训练、关节活动度训练、转移能力训练、日常生活活动能力训练以及其他训练(心理指导,呼吸功能训练,出院后的指导如家居环境改造、家庭康复方案及复诊计划等)。主要观察指标:分别于置换前和置换后12周采用Harris髋关节评分及WOMAC量表对入选患者进行功能评定。放射学评定包括置换前测量股骨皮质指数和CC值,置换后测量两组的假体柄髓腔内充填率,并动态观察股骨假体骨结合情况、髋臼杯固定情况以及假体有无松动、骨溶解、异位骨化等。结果:①两组患者均未出现术后假体脱位,未见深静脉血栓形成的临床症状,无髋部感染病例。②置换后12周随访时早期负重组患者Harris评分为(93.06±3.42)分,高于晚期负重组(86.63±5.44)分(P<0.001);WOMAC评分早期负重组(4.94±2.21)分,低于(12.19±5.26)分(P<0.001)。③股骨皮质指数和CC值及假体柄髓腔内充填率两组相比,差异亦无显著性意义(P>0.05)。置换后12周与置换后1周内的X射线平片比较,两组股骨假体均无明显下沉征象(下沉均<1mm),也无透亮线(透亮区)或反应线形成。早期负重组和晚期负重组分别有3例和5例出现"点焊"现象,所有假体均未发现小珠脱落、骨性底座、骨质溶解及异位骨化、移位等假体不稳或固定失败的征象发生。结论:早期康复、早期负重对非骨水泥型全髋关节置换后患者功能改善更明显,科学、个体化康复方案的制定必须要考虑患者的全身状况、植入假体的初始稳定性以及髋周软组织平衡等因素。
BACKGROUND： Currently, there are few rehabilitation treatment following cementless total hip arthroplasty, and most of them focus on traditional weight-bearing limitation. OBJECTIVE： To compare the effects of early and late weight loading on functional outcomes in patients undergoing total hip arthroplasty and explore feasibility to formulate scientific and individual rehabilitation program. DESIGN, TIME AND SETTING： Grouping comparative observation was performed at the Department of Orthopedics, the First Hospital of Sun Yat-sen University and the First People＇s Hospital of Guangzhou between April 2003 and March 2006. PARTICIPANTS： A total of 40 patients （42 hips） received a cementless total hip arthroplasty, including 21 males and 19 females, aged 50 years （range 32-63 years）. Finally, 30 patients with 32 hips were selected into the research. METHODS： The 30 patients were divided into two groups with 15 in each group. The patients in early full weight-bearing group were allowed to bear full weight early, while late weight-bearing was instructed to the patients in late full weight-bearing group. The preoperative and postoperative rehabilitation of the patients was similar except postoperative weight-bearing. Treatment programs included strengthening exercises to muscles, range of motion exercises, transfer training, gait training, activities of daily living （ADL） training, psychology services, breathing exercise, and discharge guides （such as environment reforming, home rehabilitation program and return visits）. MAIN OUTCOME MEASURES： The patients were evaluated functionally before and 12 weeks after surgery using the Harris hip score and Western Ontario and McMaster University Osteoarthritis Index （WOMAC）. Cortical index and CC value which related to bone quality were measured before surgery. The femoral stem canal-filling ratio was measured postoperatively. The bone growth of femoral components, acetabular fixation, component loosening, osteolysis and heterotopic ossification were assessed radiographieally. RESULTS： There were no incidences of postoperative dislocation, symptomatic deep venous thrombosis or infection in two groups. At 12 weeks after surgery the patients in early full weight-bearing group gained better scores in the Harris hip scores （93.06±3.42） than late full weight-bearing group （86.63±5.44, P 〈 0.001） and lower scores in the WOMAC scores（4.94±2.21） than late full weight-bearing group （12.19±5.26, P 〈 0.001）. There was no statistical difference in cortical index, CC value and the femoral stem canal-filling ratio between the two groups （P 〉 0.05）. At 1 and 12 weeks after surgery all the stem subsidence was less than 1 ram. There was absence of reactive lines or radiolucent lines. “Spot welding” was detected in 3 hips in early full weight-bearing group and 5 hips in late full weight-bearing group. There were no incidences of bead shedding, pedestal, osteolysis or heterotopic ossification in two group at 12 weeks. There were no signs of implant instability including component migration. CONCLUSION： The patients with early rehabilitation and early full weight-bearing after cementless total hip arthroplasty gained better function. The scientific and individual rehabilitation program depends on tolerance of patients, initial implant stability and balance of soft tissue in the affected hip.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2009年第43期8469-8474,共6页
Journal of Clinical Rehabilitative Tissue Engineering Research
