Xiang Zhou, Chen Zhong, Wang Pengcheng, Zhang Kun, Liu Fan, Zhang Changqing, Wong Tak-Man, Li Wilson, Leung Frankie
34753West China Hospital of Sichuan University, Chengdu, China.
Yunnan Second People Hospital, Kunming, China.
J Orthop Surg (Hong Kong). 2021 Sep-Dec;29(3):23094990211058902. doi: 10.1177/23094990211058902.
To compare the functional status and quality of life (QoL) between patients who underwent an early mobilization scheme and those who underwent a late mobilization scheme after hip fracture fixation surgery in elderly Chinese patients.
This was a prospective cohort study. Patients (≥65 years old) with unstable intertrochanteric fractures treated with intramedullary nails were recruited from nine centers in China. Study centers either performed early mobilization or late mobilization scheme. All patients performed immediate in-bed mobilization after surgery and followed a standardized daily exercise program at home during the first 12 weeks. Functional status was measured by the Modified Barthel Index at postoperative visit, 6 weeks, and 12 weeks. QoL was measured by the EuroQol-5D (EQ-5D) at 12 weeks.
One hundred and forty-eight patients were enrolled to early mobilization, and 136 to late mobilization. At 6 weeks, early mobilization resulted in a significantly better Modified Barthel Index than late mobilization (mean [SD]: 83.7 [12.0] vs. 67.0 [17.5], < .001). Adjusted mixed effects model showed significantly higher Modified Barthel Index for early mobilization at postoperative visit, 6 weeks, and 12 weeks (all < .001). Patients in the early mobilization group had slightly better EQ-5D Index at 12 weeks than patients in the late mobilization group (mean: 0.91 vs 0.87, = .002).
Early postoperative mobilization resulted in better functional outcomes up to 12 weeks. QoL was rated statistically significantly better in the early mobilization group, but the difference was small and may not be clinically relevant.
比较中国老年患者髋部骨折内固定术后早期活动方案组与晚期活动方案组患者的功能状态和生活质量（QoL）。
这是一项前瞻性队列研究。从中国9个中心招募年龄≥65岁、采用髓内钉治疗的不稳定型转子间骨折患者。研究中心分别实施早期活动或晚期活动方案。所有患者术后立即进行床上活动，并在术后12周内在家中遵循标准化的日常锻炼计划。在术后随访、6周和12周时，采用改良Barthel指数评估功能状态。在12周时，采用欧洲五维健康量表（EQ-5D）评估生活质量。
148例患者被纳入早期活动组，136例被纳入晚期活动组。在6周时，早期活动组的改良Barthel指数显著优于晚期活动组（均值[标准差]：83.7[12.0]对67.0[17.5]，P<0.001）。调整后的混合效应模型显示，在术后随访、6周和12周时，早期活动组的改良Barthel指数显著更高（均P<0.001）。早期活动组患者在12周时的EQ-5D指数略高于晚期活动组患者（均值：0.91对0.87，P=0.002）。
术后早期活动在12周内可带来更好的功能结局。早期活动组的生活质量在统计学上显著更好，但差异较小，可能不具有临床相关性。
