杨玉霞++倘艳锋+蔡鸿敏++范茹++刘又文

[摘要] 目的 探討路径化康复锻炼对CroweⅣ型髋关节发育不良行全髋关节置换联合转子下短缩截骨手术患者功能康复的影响。 方法 选择2012年1月～2015年10月在河南省洛阳正骨医院（河南省骨科医院）髋部损伤二科行全髋关节置换联合转子下短缩截骨手术治疗的20例髋关节CroweⅣ型患者作为研究对象，均行路径化康复锻炼。观察术后双下肢长度、术后并发症，记录术前、术后1年髋关节Harris评分。 结果 20例患者均获随访，随访时间平均30个月（13～50个月）。术后1年患肢髋关节Harris评分[（82.7±4.2）分]高于术前[（42.7±2.8）分]，差异有统计学意义（P < 0.05）。随访期间1例患者发生假体脱位，给予复位；4例出现坐骨神经损伤，经保守康复治疗均好转；2例截骨端延迟愈合，保守治疗后完全愈合；4例术后仍存在轻微跛行和肢体短缩，关节功能未受累。 结论 路径化康复锻炼可加快CroweⅣ型髋关节发育不良行全髋关节置换联合转子下短缩截骨手术患者的功能康复，预防并发症发生。

[关键词] 髋关节发育不良；全髋关节置换；转子下短缩截骨手术；路径化康复锻炼

[中图分类号] R681.1 [文献标识码] A [文章编号] 1673-7210（2017）09（b）-0142-05

Effects of rehabilitation pathway on functional restoration in patients with CroweⅣ developmental dysplasia of hip underwent total hip arthroplasty combined with subtrochanteric osteotomy

YANG Yuxia TANG Yanfeng CAI Hongmin FAN Ru LIU Youwen

The Second Department of Hip Injury， Luoyang Orthopaedic Hospital of He′nan Province （He′nan Orthopaedic Hospital）， He′nan Province， Luoyang 471002， China

[Abstract] Objective To evaluate the effects of rehabilitation pathway on functional restoration in patients with CroweⅣ developmental dysplasia of hip underwent total hip arthroplasty combined with subtrochanteric osteotomy. Methods Twenty patients with CroweⅣ developmental dysplasia of hip underwent total hip arthroplasty combined with subtrochanteric osteotomy in the Second Department of Hip Injury， Luoyang Orthopaedic Hospital of He'nan Province from January 2012 to October 2015 were selected as research objects， all patients were taken postoperative rehabilitation pathway. Postoperative lower extremity length and complications were observed， and preoperative and one-year postoperative hip Harris scores were recorded. Results All patients were followed-up postoperatively， with average of 30 months （13-50 months）. The one-year postoperative hip Harris score [（82.7±4.2） points] was higher than that before operation [（42.7±2.8） points]， with statistically significant difference （P < 0.05）. During follow up， one patient had hip prosthesis dislocation and the patient was treated successfully by reduction； four patients had sciatic nerve injury and they were recovered by conservative rehabilitation； two patients with delayed union were healed after conservative rehabilitation； four patients remained mild claudication and shortening of the lower extremities， but the function of hip joints remained good. Conclusion Postoperative rehabilitation pathway can accelerate functional restoration and prevent complications of patients with CroweⅣ developmental dysplasia of hip underwent total hip arthroplasty combined with subtrochanteric osteotomy.

[Key words] Developmental dysplasia of hip； Total hip arthroplasty； Subtrochanteric osteotomy； Rehabilitation pathway

成人髋关节发育不良（developmental dysplasia of hip，DDH）是由于先天性髋臼发育不良，对股骨头的包容不足甚至关节脱位，随着后期活动而致关节退变，影响关节功能[1-2]。成人CroweⅣ型DDH患者多为年轻人，明显的跛行和活动受限致使其有着严重的自卑心理，同时对能够恢复正常抱有很大的期望，但是病情的复雜程度决定了手术难度大，容易发生多种并发症[3-4]。康复护理的早期介入对术后并发症的预防不容忽视。围术期路径化康复锻炼可促使患者尽早恢复关节功能及生活自理能力，使患者获得最大限度的康复。本研究将围术期路径化康复护理应用于行全髋关节置换联合转子下短缩截骨手术治疗的CroweⅣ型DDH患者，取得了满意效果。现报道如下：

1 资料与方法