髋部骨折手术后在急性病房实施渐进性力量训练的可行性。
Feasibility of progressive strength training implemented in the acute ward after hip fracture surgery.
作者信息
Kronborg Lise, Bandholm Thomas, Palm Henrik, Kehlet Henrik, Kristensen Morten Tange
机构信息
Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Copenhagen University Hospital, Hvidovre, Denmark; Department of Physical Therapy, Copenhagen University Hospital, Hvidovre, Denmark.
Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Copenhagen University Hospital, Hvidovre, Denmark; Department of Physical Therapy, Copenhagen University Hospital, Hvidovre, Denmark; Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark; Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark.
出版信息
PLoS One. 2014 Apr 3;9(4):e93332. doi: 10.1371/journal.pone.0093332. eCollection 2014.
IMPORTANCE
Patients with a hip fracture lose more than 50% knee-extension strength in the fractured limb within one week of surgery. Hence, immediate progressive strength training following hip fracture surgery may be rational, but the feasibility unknown.
OBJECTIVE
To examine the feasibility of in-hospital progressive strength training implemented in the acute ward following hip fracture surgery, based on pre-specified criteria for feasibility.
DESIGN, SETTING AND PATIENTS: A prospective cohort study conducted in an acute orthopedic hip fracture unit at a university hospital. A consecutive sample of 36 patients, 18 with a cervical and 18 with a trochanteric hip fracture (27 women and 9 men, mean (SD) age of 79.4 (8.3) years) were included between June and December 2012.
INTERVENTION
A daily (on weekdays) program of progressive knee-extension strength training for the fractured limb, using ankle weight cuffs in 3 sets of 10 repetition maximum loadings.
MAIN OUTCOMES AND MEASURES
The primary outcome was the change in training load (kg) during the knee-extension strength training. The secondary outcomes were changes in hip fracture-related pain and maximal isometric knee-extension strength.
RESULTS
The strength training was commenced at a mean of 2.4 (0.7) days after surgery. The training loads (kilograms lifted) increased from 1.6 (0.8) to 4.3 (1.7) kg over 4.3 (2.2) training sessions (P<.001). The maximal isometric knee-extension strength of the fractured limb increased from 0.37 (0.2) to 0.61 (0.3) Nm/kg (P<.001), while the average strength deficit in the fractured limb decreased from 50% to 32% (% non-fractured, P<.001). Only 3 of 212 sessions were not performed because of severe hip fracture-related pain.
CONCLUSION AND RELEVANCE
Progressive knee-extension strength training of the fractured limb commenced in the acute ward seems feasible, and may reduce strength asymmetry between limbs without hip pain interfering. The clinical efficacy needs confirmation in a randomized controlled design.
TRIAL REGISTRATION
ClinicalTrials.gov ID: NCT01616030.
重要性
髋部骨折患者在术后一周内患侧下肢膝关节伸展力量丧失超过50%。因此，髋部骨折手术后立即进行渐进性力量训练可能是合理的，但可行性尚不清楚。
目的
根据预先设定的可行性标准，研究髋部骨折手术后在急性病房实施院内渐进性力量训练的可行性。
设计、地点和患者：在一家大学医院的急性骨科髋部骨折病房进行的一项前瞻性队列研究。2012年6月至12月纳入了36例连续样本患者，其中18例为颈椎骨折，18例为转子间髋部骨折（女性27例，男性9例，平均（标准差）年龄79.4（8.3）岁）。
干预措施
针对患侧下肢进行每日（工作日）渐进性膝关节伸展力量训练计划，使用踝部负重袖套，进行3组，每组10次重复的最大负荷训练。
主要结局和测量指标
主要结局是膝关节伸展力量训练期间训练负荷（千克）的变化。次要结局是髋部骨折相关疼痛和最大等长膝关节伸展力量的变化。
结果
力量训练平均在术后2.4（0.7）天开始。在4.3（2.2）次训练过程中，训练负荷（举起的千克数）从1.6（0.8）千克增加到4.3（1.7）千克（P<0.001）。患侧下肢最大等长膝关节伸展力量从0.37（0.2）牛米/千克增加到0.61（0.3）牛米/千克（P<0.001），而患侧下肢平均力量 deficit从50%降至32%（非骨折侧百分比，P<0.001）。212次训练中只有3次因严重的髋部骨折相关疼痛而未进行。
结论及相关性
在急性病房开始对患侧下肢进行渐进性膝关节伸展力量训练似乎是可行的，并且可以减少双下肢力量不对称，而不会受到髋部疼痛的干扰。临床疗效需要在随机对照设计中得到证实。
试验注册
ClinicalTrials.gov标识符：NCT01616030。
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