系统性功能锻炼对人工全髋置换术后患者康复的研究
|
摘要
目的：本研究试图通过总结、归纳前人以及本人导师多年来在人工全髋置换术后功能康复方面所取得的宝贵经验,以及在预实验的基础上,探索出较目前所报道的相关人工全髋置换术后功能锻炼方法的一套系统的、合理的功能锻炼方法,拟在临床中加以验证,从而促进患者恢复体力,增加关节活动度,增强患肢肌力,降低术后并发症,提高生活质量。
方法：按照纳入病例的标准选择单侧人工全髋置换术后的患者40例,并随机分为实验组(n=20)和对照组(n=20),分别对其指导系统性功能锻炼和常规性功能锻炼,同时记录每个观察时点所测得的数据,收集所有数据,进行统计学处理,比较二者是否具有显著性差异。
结果：通过对髋关节活动度、患肢的肌力、功能独立性评定FIM的得分进行比较,实验组均明显优于对照组,两者相比P<0.05,差异有显著性。
结论：系统性功能锻炼对于人工全髋置换术后患者的康复,是一套行之有效的功能锻炼方法,它具有系统性、科学性、渐进性、可操作性。它可促进患者恢复体力,增加髋关节的活动度,增强患肢肌力,有效降低因长期卧床带来的诸如呼吸系统、泌尿系统感染等并发症,明显提高患者的生活质量,从而提高手术的成功率。故其对髋关节疾病的术后治疗具有一定的临床指导意义。
Objective:According to the precious experience of predecessors and my advisor on the functional rehabilitation after total hip replacement and basing on the results of our preliminary experiment, we want to find a set of method of functional rehabilitation after total hip replacement, which is more systemic and more scientific to recover the physical strength, increase the muscle power, lower the postoperative complications, and raise the quality of life.
Methods:According to the choosing standard,40 patients with single lateral total hip replacement were randomly divided into experimental group (n=20) and control group (n=20). The experimental group received guidance of systemic functional exercise and the control group received guidance of routine functional exercise. The hip joint range of motion, the muscle force of affected limb and the function evaluation of affected limb of the two groups were measured and statistically compared.
Results:The clinical effects of experimental group were better than control group. There were significant difference between two groups in hip joint range of motion, muscle force of affected limb, and the function evaluation of affected limb (P<0.05).
Conclusion:The method of systemic functional exercise is helpful for postoperative functional rehabilitation of total hip replacement. It has characteristics of systemic, scientific, gradual, and operable. This method can promote the recovery of physical strength, increase the muscle power, lower the respiratory system and urinary system complications caused by long-term bed, and raise the quality of life. So the method of systemic functional exercise has very important directional significance for the treatment of hip joint diseases.
方法：按照纳入病例的标准选择单侧人工全髋置换术后的患者40例,并随机分为实验组(n=20)和对照组(n=20),分别对其指导系统性功能锻炼和常规性功能锻炼,同时记录每个观察时点所测得的数据,收集所有数据,进行统计学处理,比较二者是否具有显著性差异。
结果：通过对髋关节活动度、患肢的肌力、功能独立性评定FIM的得分进行比较,实验组均明显优于对照组,两者相比P<0.05,差异有显著性。
结论：系统性功能锻炼对于人工全髋置换术后患者的康复,是一套行之有效的功能锻炼方法,它具有系统性、科学性、渐进性、可操作性。它可促进患者恢复体力,增加髋关节的活动度,增强患肢肌力,有效降低因长期卧床带来的诸如呼吸系统、泌尿系统感染等并发症,明显提高患者的生活质量,从而提高手术的成功率。故其对髋关节疾病的术后治疗具有一定的临床指导意义。
Objective:According to the precious experience of predecessors and my advisor on the functional rehabilitation after total hip replacement and basing on the results of our preliminary experiment, we want to find a set of method of functional rehabilitation after total hip replacement, which is more systemic and more scientific to recover the physical strength, increase the muscle power, lower the postoperative complications, and raise the quality of life.
Methods:According to the choosing standard,40 patients with single lateral total hip replacement were randomly divided into experimental group (n=20) and control group (n=20). The experimental group received guidance of systemic functional exercise and the control group received guidance of routine functional exercise. The hip joint range of motion, the muscle force of affected limb and the function evaluation of affected limb of the two groups were measured and statistically compared.
Results:The clinical effects of experimental group were better than control group. There were significant difference between two groups in hip joint range of motion, muscle force of affected limb, and the function evaluation of affected limb (P<0.05).
Conclusion:The method of systemic functional exercise is helpful for postoperative functional rehabilitation of total hip replacement. It has characteristics of systemic, scientific, gradual, and operable. This method can promote the recovery of physical strength, increase the muscle power, lower the respiratory system and urinary system complications caused by long-term bed, and raise the quality of life. So the method of systemic functional exercise has very important directional significance for the treatment of hip joint diseases.
引文
[1]Opitz JL. Reconstructive surgery of the extremities [J]. Krusen's handbook of physical medicine and rehabilitation,1990,915-917.
[2]Geneva. Internationa lassification of Impairments Disabilitie, and handicap [M]. Switzerland: Word Health Organization,1980,223.
[3]Hironobu Sashik,Yoshiko Matsuba,Yuka Watanabe, et al. Home Program of Physical Therap Effect on Disabilities of Patients With Total Hip Arthroplasty[J]. Arch Phys Med Rehabil,1996,77(3):213-216.
[4]Julia Suarez, Juan Arguelles, Maruna Costales,et al. Factors Influencing the return to Work of Patients After Hip Replacement and rehabilitation [J]. Arch Phys Med Rehabil,1996, 256.
[5]体育保健学教材组编.体育保健学[M].高等教育出版社,1997,200.
[6]田麦久.运动训练学[M].人民体育出版社,2000,155.
[7]励建安.运动疗法的历史与未来[J].中国康复医学杂志,2003,18(4)：68.
[8]李传武,刘向辉.关于运动康复训练过程的思考[J].邵阳学院学报(自然科学版),2007,4(1)：109-112.
[9]刘思融等主编.马克思主义原理教程[M].北京：中国经济出版社,1989,309.
[10]张新华.试论运动康复训练原则体系[J].齐齐哈尔大学学报,2009,11(6)：172-173.
[11]毛宾尧.人工髋关节外科学[M].人民卫生出版社,2001,48.
[12]Roach KE, Miles TP. Normal hip and knee active range of motion [J]. The relationship to age of Phys Ther,1991,71(4):656.
[13]Kaufman KR, Chao EYS, Stauffer RN. Biomechanics in Morrey BF ed Reconstructive Surgery of joints [M].2 ed. Living stone:New York,1996,911-926.
[14]毛宾尧.人工髋关节外科学[M].人民卫生出版社,2001,49.
[15]吕厚山.人工关节外科学[M].第1版.北京：科学出版社,1998,13-14.
[16]Crownishield RD, Brand RA, Johnston RC. The effects of walking velocity and age on hip kinematics and kinetics [M]. Clin,1978,132:140.
[17]Crownishield RD, Johnston RC, Andrew JG. Brand RA a biomechanical investigation of the human hip [M]. Biomech,1978,11:75-85.
[18]付波,杨路,闵宏巍,等.人工全髋关节置换术后的康复[J].黑龙江医学,2003,27(4)：280.
[19]吕厚山.人工关节外科学[M].第1版.北京：科学出版社,1998,226-227.
[20]张箐,李敏,杜杏利.早期康复训练对髋关节置换术后患者功能恢复的影响[J].护理学杂志,2005,20(22)：70-71.
[21]杜杏利,方汉萍,陈海霞,等.双侧全髋置换术病人住院期间步行能力恢复的护理程序[J].现代 康复,2001,5(10)：134-135.
[22]吕厚山.人工关节外科学[M].第1版.北京：科学出版社,1998,176-177.
[23]范振华主编.骨科康复医学[M].上海医科大学出版社,1999,141.
[24]朱红英.人工全髋关节置换术后的康复及护理84例[J].中国实用护理杂志,2004,20(1)：16-17.
[25]方汉萍.全髋关节置换术后不同时间开始康复训练的效果研究[J].中华护理杂志,2006,41(1)：16--20.
[26]王慧玲,张晓乎.髋关节鬣换术后脱位的原因分析及护理对策[J].中华护理杂志,2003,38(9)：685--687.
[27]杜杏利,张箐,方汉萍,等.老年患者非骨水泥固定型全髋关节置换术后早期负重锻炼的效果[J].中华护理杂志,2004,39(12)：881--883.
[28]汪美瑛.全髋关节置换术的护理查房[J].中医正骨,2003,15(6)：14.
[29]毛宾尧.人工髋关节外科学[M].人民卫生出版社,2001,199.
[30]吕厚山.人工关节外科学[M].第2版.北京：科学出版社,1999：180-182.
[31]Silbersack Y, Taute BM, Hein W, et al. Bone Jiont Surg[M]. Br,2004,86(6):809-812.
[32]Herzog R, Morseher E. Treatment of infected total prosthesis arthroplasty of the hip joint[J]. Orthopade,1995,24(4):326-334.
[33]Scherpereel PA, Tavernier B. Perioperative care of diabetes patients [M]. Eur Anasesth, 2001,18:299-294.
[34]刘英明,刘连祥.心理治疗“三步法”指导骨折患者康复期功能锻炼[J].中国康复理论与实践,2003,9(2)：124-128.
[35]施楚君,张连春.康复训练程序在全髋关节置换病人中的应用[J].中国实用护理杂志,2004,20(245)：28-29.
[36]沈研.同期双侧全膝、全髋关节置换术的临床护理分析[J].现代护理,2003,9(9)：737-738.
[37]吕厚山.人工关节外科学[M].第1版.北京：科学出版社,1998,226.
[38]王彤,顾晓园,周仕枋,等.全髋关节置换术后康复训练程序[J].中国康复理论与实践,2000,6(3)：139-140.
[39]任燕春.全髋关节置换术的隧术期管理及康复训练[J].临床与实践,2009,13(3)：200-201.
[40]方雅君,王伟华,李宁川.人工全髋关节置换术患者的康复指导[J].吉林医学,2008,29(22)：2009-2010.
[41]吕厚山.人工关节外科学[M].第1版.北京：科学出版社,1998,229-230
[42]董天华,卢世壁.髋关节外科学[M].郑州：郑州大学出版社,2005,108.
[43]Kendall FP, Mc Creary EK. Muscle Testing and Function [M].3rd ed. Williams and Wilkins,1983,199.
[44]周士枋,范振华.实用康复学[M].第二版.南京：东南大学出版社,1998,223.
[45]杜克,王守志.骨科护理学[M].北京人民卫生出版社,1995,730-743.
[1]Buohhot ZHW,llson RA, Lodenkanper H. Management of deep infections of total hip replacement [J] J Bone Joint Surge 1981,6313 (4):342.
[2]罗先正,邱贵兴.人工髋关节学[M].北京：中国协和医科大学出版社,2003：342.
[3]Willson DF, Lan drigan CP, Horn SD,et al.Complications in infants hospitalized for bronchiolitis or respiratory syncytial virus pneumonia[J]. J Pediatr,2003,143(suppl5):142-149.
[4]邓莹。杨楠芳。王延方. 第三代人工全膝关节置换围手术期护理口].实用诊断与治疗杂志,2003,17(3)：234.
[5]Karla CL,Amy SK. Positive intraoperative cultures and canine total hip replacement:Risk factors, periprosthetie infection, and surgical success [J]. Journal of the American and Animal Hospital Association Lakewood,2002,38(3):271.
[6]朱震安,戴射戎.人工关节周围深部感染的预防[J].中国矫形外科杂志。2001,8(3)297-298.
[7]Sweetman LL,Ng YT,Butler IJ,et al.Neurologic complica-tions associated with respiratory syncytial virus [J].Pe-diatric Neurology,2005,32(5):307-310.
[8]Solomon DH, Losina E, Baron JA, et al. Contribution of hospital characteristics to the volumeoutcome relationship:dislocation and infection following total hip replacement surgery[J]. Arthritis & Rheumatism,2002,46(9):2436-2444.
[9]Jefrey NK, Eleua L, Jane B, et al. Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the United States medicare population[J]. J Bone Joint Surg Am,2001,8(11)1622-1625.
[10]Pierriek B, Jose L, Emmanuel C, et al. Compliance with guidelines onantibiotic prothylaxis in total hip replacement surgery:results of a retrospective study of 416 patients in a teaching hospital[J]. Infection Control and Hospital Epidemiology Thorofare,2004.25(4):302-307. Control and Hospital Epidemiology Thorofare,2004.25(4):302-307.
[11]Dan S, Edward JH, Ross K L, et al. Is homologous blood transfusion a risk factor for infection after hip replacement? [J]. Canadian Journal of Surgery Ottawa,2001,44(5):355-358
[12]Aglietti P, Baldini A. Risk factors and prevention of infections of hip and knee prostheses[J]. Journal of Chemotherapy,2000,12(2):15-22.
[13]Spangehl MI. Mash BA. O Coned[.a]Prospecfve analysis to preope Ta, eand inl raoperatie invtlgatlons for the ditgnosis Infection at the sites off two hundred and two revision total Hip arthimplasties[J] J bone Joint surg(AM),1999.81:672-683.
[14]Spangehl MJ, Younger SF, Maasri, et al. Diagnosis of infection following to tal hip arthmplasty [J]Istrl Course Lect,1998.47:285-295.
[15]王爱民.人工关节技术规范化操作十分重要.中华创伤杂志,2005.21：804-805.
[16]Herzog R, Morseher E. Treatment of infected total prosthesis arthroplasty of the hip joint[J]. Orthopade, 1995,24(4):326-334.
[17]Mitchell PA, Masri BA, Garbuz DS, et al. Cementless revision for infection following total hip arthroplasty. Instr Course Lect,2003,52:323-330.
[18]De Palma L, Greco F, Ciarpaglini C, et al. The mechanical proper-ties of"cement-antibiotic"mixtures.Ital J Orthop Traumatol,1982,8:461-467.
[19]Durbhakula SM, Czajka J, Fuchs MD, et al. Antibiotic-loaded, articulating cement spacers in the 2-stage exchange of infected total knee arthroplasty [J]. J Arthroplasty,2004,19(6):768-774.
[20]Haddad FS, Muirhead-A Ⅱwood SK, M anktelow AR, etal. Twostage uncemented revision hip arthroplasty for infection. J Bone Joint Surg(Br),2000,82(5):689.
[2]Geneva. Internationa lassification of Impairments Disabilitie, and handicap [M]. Switzerland: Word Health Organization,1980,223.
[3]Hironobu Sashik,Yoshiko Matsuba,Yuka Watanabe, et al. Home Program of Physical Therap Effect on Disabilities of Patients With Total Hip Arthroplasty[J]. Arch Phys Med Rehabil,1996,77(3):213-216.
[4]Julia Suarez, Juan Arguelles, Maruna Costales,et al. Factors Influencing the return to Work of Patients After Hip Replacement and rehabilitation [J]. Arch Phys Med Rehabil,1996, 256.
[5]体育保健学教材组编.体育保健学[M].高等教育出版社,1997,200.
[6]田麦久.运动训练学[M].人民体育出版社,2000,155.
[7]励建安.运动疗法的历史与未来[J].中国康复医学杂志,2003,18(4)：68.
[8]李传武,刘向辉.关于运动康复训练过程的思考[J].邵阳学院学报(自然科学版),2007,4(1)：109-112.
[9]刘思融等主编.马克思主义原理教程[M].北京：中国经济出版社,1989,309.
[10]张新华.试论运动康复训练原则体系[J].齐齐哈尔大学学报,2009,11(6)：172-173.
[11]毛宾尧.人工髋关节外科学[M].人民卫生出版社,2001,48.
[12]Roach KE, Miles TP. Normal hip and knee active range of motion [J]. The relationship to age of Phys Ther,1991,71(4):656.
[13]Kaufman KR, Chao EYS, Stauffer RN. Biomechanics in Morrey BF ed Reconstructive Surgery of joints [M].2 ed. Living stone:New York,1996,911-926.
[14]毛宾尧.人工髋关节外科学[M].人民卫生出版社,2001,49.
[15]吕厚山.人工关节外科学[M].第1版.北京：科学出版社,1998,13-14.
[16]Crownishield RD, Brand RA, Johnston RC. The effects of walking velocity and age on hip kinematics and kinetics [M]. Clin,1978,132:140.
[17]Crownishield RD, Johnston RC, Andrew JG. Brand RA a biomechanical investigation of the human hip [M]. Biomech,1978,11:75-85.
[18]付波,杨路,闵宏巍,等.人工全髋关节置换术后的康复[J].黑龙江医学,2003,27(4)：280.
[19]吕厚山.人工关节外科学[M].第1版.北京：科学出版社,1998,226-227.
[20]张箐,李敏,杜杏利.早期康复训练对髋关节置换术后患者功能恢复的影响[J].护理学杂志,2005,20(22)：70-71.
[21]杜杏利,方汉萍,陈海霞,等.双侧全髋置换术病人住院期间步行能力恢复的护理程序[J].现代 康复,2001,5(10)：134-135.
[22]吕厚山.人工关节外科学[M].第1版.北京：科学出版社,1998,176-177.
[23]范振华主编.骨科康复医学[M].上海医科大学出版社,1999,141.
[24]朱红英.人工全髋关节置换术后的康复及护理84例[J].中国实用护理杂志,2004,20(1)：16-17.
[25]方汉萍.全髋关节置换术后不同时间开始康复训练的效果研究[J].中华护理杂志,2006,41(1)：16--20.
[26]王慧玲,张晓乎.髋关节鬣换术后脱位的原因分析及护理对策[J].中华护理杂志,2003,38(9)：685--687.
[27]杜杏利,张箐,方汉萍,等.老年患者非骨水泥固定型全髋关节置换术后早期负重锻炼的效果[J].中华护理杂志,2004,39(12)：881--883.
[28]汪美瑛.全髋关节置换术的护理查房[J].中医正骨,2003,15(6)：14.
[29]毛宾尧.人工髋关节外科学[M].人民卫生出版社,2001,199.
[30]吕厚山.人工关节外科学[M].第2版.北京：科学出版社,1999：180-182.
[31]Silbersack Y, Taute BM, Hein W, et al. Bone Jiont Surg[M]. Br,2004,86(6):809-812.
[32]Herzog R, Morseher E. Treatment of infected total prosthesis arthroplasty of the hip joint[J]. Orthopade,1995,24(4):326-334.
[33]Scherpereel PA, Tavernier B. Perioperative care of diabetes patients [M]. Eur Anasesth, 2001,18:299-294.
[34]刘英明,刘连祥.心理治疗“三步法”指导骨折患者康复期功能锻炼[J].中国康复理论与实践,2003,9(2)：124-128.
[35]施楚君,张连春.康复训练程序在全髋关节置换病人中的应用[J].中国实用护理杂志,2004,20(245)：28-29.
[36]沈研.同期双侧全膝、全髋关节置换术的临床护理分析[J].现代护理,2003,9(9)：737-738.
[37]吕厚山.人工关节外科学[M].第1版.北京：科学出版社,1998,226.
[38]王彤,顾晓园,周仕枋,等.全髋关节置换术后康复训练程序[J].中国康复理论与实践,2000,6(3)：139-140.
[39]任燕春.全髋关节置换术的隧术期管理及康复训练[J].临床与实践,2009,13(3)：200-201.
[40]方雅君,王伟华,李宁川.人工全髋关节置换术患者的康复指导[J].吉林医学,2008,29(22)：2009-2010.
[41]吕厚山.人工关节外科学[M].第1版.北京：科学出版社,1998,229-230
[42]董天华,卢世壁.髋关节外科学[M].郑州：郑州大学出版社,2005,108.
[43]Kendall FP, Mc Creary EK. Muscle Testing and Function [M].3rd ed. Williams and Wilkins,1983,199.
[44]周士枋,范振华.实用康复学[M].第二版.南京：东南大学出版社,1998,223.
[45]杜克,王守志.骨科护理学[M].北京人民卫生出版社,1995,730-743.
[1]Buohhot ZHW,llson RA, Lodenkanper H. Management of deep infections of total hip replacement [J] J Bone Joint Surge 1981,6313 (4):342.
[2]罗先正,邱贵兴.人工髋关节学[M].北京：中国协和医科大学出版社,2003：342.
[3]Willson DF, Lan drigan CP, Horn SD,et al.Complications in infants hospitalized for bronchiolitis or respiratory syncytial virus pneumonia[J]. J Pediatr,2003,143(suppl5):142-149.
[4]邓莹。杨楠芳。王延方. 第三代人工全膝关节置换围手术期护理口].实用诊断与治疗杂志,2003,17(3)：234.
[5]Karla CL,Amy SK. Positive intraoperative cultures and canine total hip replacement:Risk factors, periprosthetie infection, and surgical success [J]. Journal of the American and Animal Hospital Association Lakewood,2002,38(3):271.
[6]朱震安,戴射戎.人工关节周围深部感染的预防[J].中国矫形外科杂志。2001,8(3)297-298.
[7]Sweetman LL,Ng YT,Butler IJ,et al.Neurologic complica-tions associated with respiratory syncytial virus [J].Pe-diatric Neurology,2005,32(5):307-310.
[8]Solomon DH, Losina E, Baron JA, et al. Contribution of hospital characteristics to the volumeoutcome relationship:dislocation and infection following total hip replacement surgery[J]. Arthritis & Rheumatism,2002,46(9):2436-2444.
[9]Jefrey NK, Eleua L, Jane B, et al. Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the United States medicare population[J]. J Bone Joint Surg Am,2001,8(11)1622-1625.
[10]Pierriek B, Jose L, Emmanuel C, et al. Compliance with guidelines onantibiotic prothylaxis in total hip replacement surgery:results of a retrospective study of 416 patients in a teaching hospital[J]. Infection Control and Hospital Epidemiology Thorofare,2004.25(4):302-307. Control and Hospital Epidemiology Thorofare,2004.25(4):302-307.
[11]Dan S, Edward JH, Ross K L, et al. Is homologous blood transfusion a risk factor for infection after hip replacement? [J]. Canadian Journal of Surgery Ottawa,2001,44(5):355-358
[12]Aglietti P, Baldini A. Risk factors and prevention of infections of hip and knee prostheses[J]. Journal of Chemotherapy,2000,12(2):15-22.
[13]Spangehl MI. Mash BA. O Coned[.a]Prospecfve analysis to preope Ta, eand inl raoperatie invtlgatlons for the ditgnosis Infection at the sites off two hundred and two revision total Hip arthimplasties[J] J bone Joint surg(AM),1999.81:672-683.
[14]Spangehl MJ, Younger SF, Maasri, et al. Diagnosis of infection following to tal hip arthmplasty [J]Istrl Course Lect,1998.47:285-295.
[15]王爱民.人工关节技术规范化操作十分重要.中华创伤杂志,2005.21：804-805.
[16]Herzog R, Morseher E. Treatment of infected total prosthesis arthroplasty of the hip joint[J]. Orthopade, 1995,24(4):326-334.
[17]Mitchell PA, Masri BA, Garbuz DS, et al. Cementless revision for infection following total hip arthroplasty. Instr Course Lect,2003,52:323-330.
[18]De Palma L, Greco F, Ciarpaglini C, et al. The mechanical proper-ties of"cement-antibiotic"mixtures.Ital J Orthop Traumatol,1982,8:461-467.
[19]Durbhakula SM, Czajka J, Fuchs MD, et al. Antibiotic-loaded, articulating cement spacers in the 2-stage exchange of infected total knee arthroplasty [J]. J Arthroplasty,2004,19(6):768-774.
[20]Haddad FS, Muirhead-A Ⅱwood SK, M anktelow AR, etal. Twostage uncemented revision hip arthroplasty for infection. J Bone Joint Surg(Br),2000,82(5):689.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |