Hida Mitsumasa, Deguchi Yuko, Miyaguchi Kazuya, Nakazono Masako, Hirata Naoki, Nakagawa Rie, Kitayama Atsushi
School of Rehabilitation, Osaka Kawasaki Rehabilitation University, Osaka, Japan.
Nara Yukokai Hospital, Nara, Japan.
Prog Rehabil Med. 2018 Jun 23;3:20180012. doi: 10.2490/prm.20180012. eCollection 2018.
The intensity of pain after surgical treatment of hip fracture has a negative effect on functional recovery. However, the effects of acute postoperative pain on the recovery of walking ability after the surgery remain unclear. This study aimed to investigate the association between acute postoperative pain and the recovery of functional gait among patients who had independent walking ability prior to hip fracture.
This was an observational study that included 41 patients with a mean age of 81.3±7.3 years who underwent surgical treatment for traumatic hip fracture at a general hospital. The primary outcome was the time to recovery of independent gait postsurgery. Based on the median time to recovery, patients were classified into an early independent walking group and an independent walking group. Stepwise logistic regression analysis was performed to identify predictive factors of the time to recovery of independent walking.
The median time to recovery of independent gait was 24 days (range, 7-50 days). In total, 20 patients were classified in the early independent walking group and 21 in the independent walking group. On logistic regression analysis, the total pain intensity, reported during activities of daily living (ADL) on postoperative days 5 and 6, and the knee extensor strength were predictive of the time to recovery of independent walking.
The degree of recovery of gait function of patients surgically treated for hip fracture was found to be predicted by the pain intensity measured during ADL and the knee extensor strength assessed in the acute phase. Effective management of acute pain after surgical treatment of hip fracture may help improve functional recovery of gait.
髋部骨折手术治疗后的疼痛强度对功能恢复有负面影响。然而，术后急性疼痛对手术后步行能力恢复的影响仍不清楚。本研究旨在调查髋部骨折前具有独立步行能力的患者术后急性疼痛与功能性步态恢复之间的关联。
这是一项观察性研究，纳入了41例平均年龄为81.3±7.3岁的患者，这些患者在一家综合医院接受了创伤性髋部骨折的手术治疗。主要结局是术后恢复独立步态的时间。根据恢复的中位时间，将患者分为早期独立步行组和独立步行组。进行逐步逻辑回归分析以确定独立步行恢复时间的预测因素。
独立步态恢复的中位时间为24天（范围7 - 50天）。总共有20例患者被分类到早期独立步行组，21例在独立步行组。在逻辑回归分析中，术后第5天和第6天日常生活活动（ADL）期间报告的总疼痛强度以及膝关节伸肌力量是独立步行恢复时间的预测因素。
发现髋部骨折手术治疗患者的步态功能恢复程度可通过ADL期间测量的疼痛强度和急性期评估的膝关节伸肌力量来预测。髋部骨折手术治疗后有效管理急性疼痛可能有助于改善步态的功能恢复。
