基于ERAS理念探讨电针联合等速肌力训练对THA术后患者髋关节功能的影响

doi:10.3877/cma.j.issn.2096-0263.2023.02.005

目的

探究ERAS理念下电针联合等速肌力训练对全髋关节置换术后患者髋关节功能的影响。

方法

采用完全随机化方法，将72例入组患者随机分为观察组和对照组各36例（观察组脱失1例）。观察组采用电针联合等速肌力训练疗法，对照组采用传统康复训练疗法。分别于术后1天、术后2周、术后3个月时测定并记录患者的髋关节Harris量表各维度评分、患侧大腿肌萎缩指数、Barthel指数评分，并进行疗效评价及安全性评价。

结果

所有入组患者均获随访，随访时间3个月。观察组术后2周的Harris评分[（31.09±8.33）分]、Barthel指数评分[（60.83±16.72）分]优于对照组[[（24.47±8.02）分；（37.59±4.12）分]，肌萎缩指数[（39.23±18.06）分]呈正值，对照组肌萎缩指数[（-53.17±0.59）分]呈负值；观察组术后3个月的Harris评分[（41.47±1.46）分]优于对照组[（37.59±4.12）分]，肌萎缩指数[（0.34±0.40）分]小于对照组[（3.08±0.23）分]，优良率（88.89%）优于对照组（54.29%），差异具有统计学意义（均P<0.05）。观察组和对照组术前、术后2周、术后3个月Harris评分、Barthel评分、肌萎缩指数进行重复测量设计的方差分析显示观察组和对照组组间差异具有统计学意义（均P<0.05），组别与时间点间存在交互作用，各时间点除第一时间点外两组差异均具有统计学意义（均P<0.05），观察组和对照组在各时间点间组内差异均具有统计学意义（均P<0.05）。

结论

电针联合等速肌力训练有助于提高THA术后患者髋关节功能及日常生活能力、改善术后水肿及防止患肢肌肉萎缩，临床疗效尤其是术后早期疗效显著且安全性良好。

关键词: 加速康复外科, 电针, 等速肌力训练, 全髋关节置换术, 疗效

Objective

To investigate the effect of electroacupuncture combined with isokinetic muscle training on hip joint function in patients undergoing total hip arthroplasty under the ERAS concept.

Methods

72 eligible patients were randomly divided into an observation group and a control group, with 36 cases in each group (one case was lost in the observation group). The observation group received electroacupuncture combined with isokinetic muscle training therapy, while the control group received traditional rehabilitation training. The Harris Hip Score, the atrophy index of the affected side thigh muscle, the Barthel Index score of the patients were measured and recorded at postoperative day 1, 2 weeks, and 3 months, and the therapeutic and safety effects were evaluated.

Results

All enrolled patients were followed up for 3 months. The Harris Hip Score and Barthel Index score of the observation group at 2 weeks after surgery were superior to those of the control group, with positive atrophy index values in the observation group and negative atrophy index values in the control group. At 3 months after surgery, the Harris Hip Score of the observation group was better than that of the control group, and the atrophy index was lower than that of the control group. The excellent rate was also better than that of the control group, and the differences were statistically significant. The repeated measures analysis of variance of the Harris Hip Score, Barthel Index score, and atrophy index of the observation and control groups before surgery, at 2 weeks and 3 months after surgery showed that there was a statistically significant difference between the two groups. There was an interaction effect between group and time point, and the differences between the two groups were statistically significant at all time points except the first time point. The differences within the observation and control groups at each time point were also statistically significant.

Conclusions

Electroacupuncture combined with isokinetic muscle training can help improve hip joint function and daily living ability, alleviate postoperative edema, and prevent muscle atrophy of the affected limb in patients after total hip arthroplasty. The clinical efficacy, especially the early postoperative efficacy, is significant, and the safety is good.

Key words: Enhanced recovery after surgery, Electroacupuncture, Isokinetic muscle strength training, Total hip arthroplasty, Curative effect

表1 两组全髋关节置换术后患者一般资料比较

组别	例数	性别（例，男/女）	年龄（岁，±s）	部位（例，左/右）	病程（d，±s）	BMI指数（±s）
观察组	36	10/26	75.03±10.02	22/14	3.34±2.18	22.50±5.27
对照组	35	12/23	76.17±10.95	23/12	4.16±2.04	23.35±4.22
t或χ²值		0.351	0.432	0.162	2.409	5.061
P值		0.614	0.187	0.806	0.116	0.899

表1 两组全髋关节置换术后患者一般资料比较

组别	例数	性别（例，男/女）	年龄（岁，±s）	部位（例，左/右）	病程（d，±s）	BMI指数（±s）
观察组	36	10/26	75.03±10.02	22/14	3.34±2.18	22.50±5.27
对照组	35	12/23	76.17±10.95	23/12	4.16±2.04	23.35±4.22
t或χ²值		0.351	0.432	0.162	2.409	5.061
P值		0.614	0.187	0.806	0.116	0.899

表2 两组全髋关节置换术后患者治疗前评估资料比较（±s）

组别	Harris量表总分（分）	肌萎缩指数（%）	Barthel指数评分（分）
观察组	25.13±7.34	6.83±0.59	23.13±8.85
对照组	24.74±8.61	-7.12±0.64	23.75±6.82
t值	0.267	0.956	2.05
P值	0.791	0.343	0.614

表2 两组全髋关节置换术后患者治疗前评估资料比较（±s）

组别	Harris量表总分（分）	肌萎缩指数（%）	Barthel指数评分（分）
观察组	25.13±7.34	6.83±0.59	23.13±8.85
对照组	24.74±8.61	-7.12±0.64	23.75±6.82
t值	0.267	0.956	2.05
P值	0.791	0.343	0.614

表3 两组全髋关节置换术后患者Harris量表各维度评分比较（分，±s）

维度	组别	例数	术后第1天	术后2周	术后3个月	F值	P值
疼痛	观察组	36	17.94±6.86	31.09±8.33^*	41.47±1.46^*#	175.787	<0.001
疼痛	对照组	35	17.55±7.96	24.47±8.02^*	37.59±4.12^*#	148.403	<0.001
	F值		0.224	12.220	27.197
	P值		0.637	0.001	<0.001
维度	组别	例数	术后第1天	术后2周	术后3个月	F值	P值
功能	观察组	36	1.76±1.10	19.53±2.80^*	38.29±5.41^*#	983.185	<0.001
功能	对照组	35	1.57±1.08	13.29±3.60^*	36.21±7.79^*#	641.955	<0.001
	F值		1.231	67.439	1.400
	P值		0.271	<0.001	0.241
维度	组别	例数	术后第1天	术后2周	术后3个月	F值	P值
畸形	观察组	36	3.06±0.81	3.45±0.50^*	3.51±0.50^*#	3.652	0.031
畸形	对照组	35	3.00±0.73	3.36±0.48^*	3.57±0.49^*#	8.008	0.001
	F值		0.595	0.148	0.356
	P值		0.443	0.702	0.553
维度	组别	例数	术后第1天	术后2周	术后3个月	F值	P值
活动范围	观察组	36	2.37±0.82	3.95±0.58^*	5.01±0.60^*#	69.638	<0.001
活动范围	对照组	35	2.62±1.07	3.53±0.85^*	4.30±0.73^*#	31.633	<0.001
	F值		0.416	6.124	17.551
	P值		0.521	0.016	<0.001
维度	组别	例数	术后第1天	术后2周	术后3个月	F值	P值
总分	观察组	36	25.13±7.34	58.04±9.14^*	88.29±5.98^*#	649.572	<0.001
总分	对照组	35	24.74±8.61	44.66±9.47^*	81.66±7.82^*#	549.417	<0.001
	F值		0.353	38.006	15.129
	P值		0.554	<0.001	<0.001

表3 两组全髋关节置换术后患者Harris量表各维度评分比较（分，±s）

维度	组别	例数	术后第1天	术后2周	术后3个月	F值	P值
疼痛	观察组	36	17.94±6.86	31.09±8.33^*	41.47±1.46^*#	175.787	<0.001
疼痛	对照组	35	17.55±7.96	24.47±8.02^*	37.59±4.12^*#	148.403	<0.001
	F值		0.224	12.220	27.197
	P值		0.637	0.001	<0.001
维度	组别	例数	术后第1天	术后2周	术后3个月	F值	P值
功能	观察组	36	1.76±1.10	19.53±2.80^*	38.29±5.41^*#	983.185	<0.001
功能	对照组	35	1.57±1.08	13.29±3.60^*	36.21±7.79^*#	641.955	<0.001
	F值		1.231	67.439	1.400
	P值		0.271	<0.001	0.241
维度	组别	例数	术后第1天	术后2周	术后3个月	F值	P值
畸形	观察组	36	3.06±0.81	3.45±0.50^*	3.51±0.50^*#	3.652	0.031
畸形	对照组	35	3.00±0.73	3.36±0.48^*	3.57±0.49^*#	8.008	0.001
	F值		0.595	0.148	0.356
	P值		0.443	0.702	0.553
维度	组别	例数	术后第1天	术后2周	术后3个月	F值	P值
活动范围	观察组	36	2.37±0.82	3.95±0.58^*	5.01±0.60^*#	69.638	<0.001
活动范围	对照组	35	2.62±1.07	3.53±0.85^*	4.30±0.73^*#	31.633	<0.001
	F值		0.416	6.124	17.551
	P值		0.521	0.016	<0.001
维度	组别	例数	术后第1天	术后2周	术后3个月	F值	P值
总分	观察组	36	25.13±7.34	58.04±9.14^*	88.29±5.98^*#	649.572	<0.001
总分	对照组	35	24.74±8.61	44.66±9.47^*	81.66±7.82^*#	549.417	<0.001
	F值		0.353	38.006	15.129
	P值		0.554	<0.001	<0.001

表4 两组全髋关节置换术后患者大腿肌萎缩指数比较（%，±s）

组别	例数	术后第1天	术后2周	术后3个月	F值	P值
观察组	36	6.83±0.59	10.0±0.36	0.34±0.40	0.474	<0.001
对照组	35	-7.12±0.64	-53.17±0.59	3.08±0.23	32.663	<0.001
F值		0.913	29.451	15.272
P值		0.343	<0.001	<0.001

表4 两组全髋关节置换术后患者大腿肌萎缩指数比较（%，±s）

组别	例数	术后第1天	术后2周	术后3个月	F值	P值
观察组	36	6.83±0.59	10.0±0.36	0.34±0.40	0.474	<0.001
对照组	35	-7.12±0.64	-53.17±0.59	3.08±0.23	32.663	<0.001
F值		0.913	29.451	15.272
P值		0.343	<0.001	<0.001

表5 两组全髋关节置换术后患者Barthel指数评分比较（分，±s）

组别	例数	术后第1天	术后2周	术后3个月	F值	P值
观察组	36	23.13±8.85	60.83±16.72^*	76.55±13.73^*#	156.931	<0.001
对照组	35	23.75±6.82	39.23±18.06^*	69.98±20.08^*#	92.179	<0.001
F值		0.013	22，589	2.975
P值		0.908	<0.001	0.089

表5 两组全髋关节置换术后患者Barthel指数评分比较（分，±s）

组别	例数	术后第1天	术后2周	术后3个月	F值	P值
观察组	36	23.13±8.85	60.83±16.72^*	76.55±13.73^*#	156.931	<0.001
对照组	35	23.75±6.82	39.23±18.06^*	69.98±20.08^*#	92.179	<0.001
F值		0.013	22，589	2.975
P值		0.908	<0.001	0.089

表6 两组全髋关节置换术后患者术后2周临床疗效比较

组别	例数	优	良	中	差	优良率（%）	秩均值
观察组	36	15	17	3	0	88.89	27.63
对照组	35	6	13	15	2	54.29	44.14
Z值		3.587
P值		<0.001

表6 两组全髋关节置换术后患者术后2周临床疗效比较

组别	例数	优	良	中	差	优良率（%）	秩均值
观察组	36	15	17	3	0	88.89	27.63
对照组	35	6	13	15	2	54.29	44.14
Z值		3.587
P值		<0.001

图1~10 患者男性，64岁，因"摔倒后左侧髋部疼痛、活动受限1天"于2022年4月5日入院，诊断为"左股骨颈骨折"。于2022年4月8日行"左全髋关节置换术"，术后予电针联合等速肌力训练治疗。图1~2　术前髋关节正侧位X线片；图3~4　术后1天髋关节正侧位X线片；图5~6　术后2周髋关节正侧位X线片；图7~8　术后接受电针治疗；图9~10　术后进行等速肌力训练

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To investigate the effect of electroacupuncture combined with isokinetic strength training on hip function of patients after THA based on ERAS concept

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To investigate the effect of electroacupuncture combined with isokinetic strength training on hip function of patients after THA based on ERAS concept