Fujita Kimie, Makimoto Kiyoko, Mawatari Masaaki
Department of Health Sciences, Graduate School of Medicine, Kyushu University, Japan.
Department of Health Sciences, Graduate School of Medicine, Osaka University, Japan.
J Orthop Sci. 2016 Mar;21(2):191-8. doi: 10.1016/j.jos.2015.11.004. Epub 2015 Dec 31.
In non-Western countries including Japan, activities requiring deep flexion of the hip joint, such as seiza (kneeling with calves tucked under the thighs and buttocks resting on the heels) and using squat toilets are commonly practiced. The purpose of this study was to assess longitudinal changes in traditional health-related quality of life measures and measures of physical functions associated with lifestyle for Japanese patients pre-surgery and after total hip arthroplasty.
Consecutive primary total hip arthroplasty patients between July 2003 and November 2006 were eligible. Patients were measured preoperatively and at 6 weeks, 1 year and 3 years postoperatively. Patients completed the EuroQol 5D, the Western Ontario and McMaster Universities Osteoarthritis Index and items related to Japanese lifestyle activities such as squatting. Changes in these scale scores across the four time points were tested, and we examined predictive factors of EuroQol 5D score at 3-year follow-up using multiple linear regression.
Of 1103 eligible patients, 576 completed questionnaires at all four time points. By 6 weeks post-surgery, reductions in pain and improvements in physical function and stiffness became highly significant, and improvements continued to 3 years postoperative. In contrast, improvements were far more limited for items related to Japanese lifestyle functions such as seiza and use of a Japanese squat toilet, even 3 years after surgery. Predictive factors of EQ5D at 3-year post THA were WOMAC pain and physical function, seiza, age and comorbidity measured at 3-year post THA.
The rate of improvement in QOL requiring deep flexion of the hip joint was much slower than that in QOL related to Western lifestyle. Our study suggests a need for lifestyle modification for THA patients in the other countries where kneeling and squatting are commonly performed.
在包括日本在内的非西方国家，人们普遍进行一些需要髋关节深度屈曲的活动，比如跪坐（小腿藏于大腿下方，臀部坐在脚后跟上）和使用蹲厕。本研究的目的是评估日本患者在全髋关节置换术前及术后与生活方式相关的传统健康相关生活质量指标和身体功能指标的纵向变化。
选取2003年7月至2006年11月期间连续接受初次全髋关节置换术的患者。在术前以及术后6周、1年和3年对患者进行测量。患者完成欧洲五维健康量表（EuroQol 5D）、西安大略和麦克马斯特大学骨关节炎指数（Western Ontario and McMaster Universities Osteoarthritis Index）以及与日本生活方式活动（如蹲姿）相关的项目。对这四个时间点这些量表得分的变化进行了测试，并使用多元线性回归分析了3年随访时欧洲五维健康量表得分的预测因素。
在1103名符合条件的患者中，有576名在所有四个时间点都完成了问卷调查。术后6周时，疼痛减轻、身体功能和僵硬程度改善非常显著，并且这种改善持续到术后3年。相比之下，即使在术后3年，与日本生活方式功能（如跪坐和使用日本蹲厕）相关的项目改善也非常有限。全髋关节置换术后3年欧洲五维健康量表得分的预测因素包括骨关节炎指数疼痛和身体功能、跪坐、年龄以及全髋关节置换术后3年测量的合并症。
需要髋关节深度屈曲的生活质量改善速度比与西方生活方式相关的生活质量改善速度慢得多。我们的研究表明，在其他经常进行跪坐和蹲姿的国家，全髋关节置换术患者需要改变生活方式。
